Prescription Drug Monitoring Programs - PDMP Center of Excellence

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Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 12A. Standardize data fields and formats across PDMPsCurrently, PDMPs vary in the data fields and formats collected from pharmacies, limiting thecomprehensiveness of data, comparability of data across states, and ease of integration with prescriptioninformation collected by potential PDMP collaborators, such as Medicaid, the Indian Health Service (IHS),Department of Veterans Affairs (VA), and Department of Defense (DoD).1. Collect data on all schedules of controlled substancesRationale: A possible best practice in data collection, widely adopted but not universal among PDMPs, isto collect prescription history information on all classes of controlled substances (Schedules II-‐V). Thispractice is included in the Alliance of States with Prescription Monitoring Programs’ PMP Model Act(ASPMP, 2010) and will permit prescribers and pharmacists to examine the full spectrum of controlledsubstance prescriptions when making clinical decisions about patients. Although opioids are perhaps themost widely abused and diverted drugs, drugs in all schedules have abuse potential. For example, by2009, there were almost as many emergency department visits associated with misuse or abuse ofbenzodiazepines (373,200) as for opioids (393,200) (SAMHSA, 2010), and persons who are seriouslyabusing drugs frequently abuse multiple controlled substances (SAMHSA, 2011). Moreover, suspectedquestionable activity (e.g., doctor shopping) is associated with being prescribed multiple classes ofdrugs. PDMPs not tracking all classes will likely underestimate the prevalence of doctor shopping (Wilseyet al., 2010) and thereby fail to inform all affected providers about problematic prescribing anddispensing. BJA has designated collecting data on all schedules a priority for PDMPs seeking fundingunder its Harold Rogers Grant Program.Evidence of effectiveness: A preliminary evaluation of Performance Measure Reports submitted byHarold Rogers grantee PDMPs to BJA suggests that states collecting Schedules II-‐V have lower rates ofdoctor shopping than states collecting fewer schedules (PDMP COE analysis of Performance MeasureData, 2011).Current adoption status: According to the Alliance of States with Prescription Monitoring Programs, of46 states that have established reporting requirements, only 29 require reporting of Schedules II-‐V; seepmpalliance.org/content/state-‐profiles-‐reports.Barriers to adoption: Tracking all drug schedules involves updating data collection systems and the needfor regulation and/or legislation changes.SummaryRationale: Prescribers need to examine all scheduled drug classes to make proper prescribing decisions;all classes are subject to abuse; collecting all schedules permits improved detection of questionableactivity.Evidence of effectiveness: Unpublished PDMP COE data analysis, expert opinion (ASPMP Model Act).Current adoption status: 46 states have established reporting requirements; 29 require reporting ofSchedules II-‐V.Barriers to adoption: Costs of updating systems, requires legislative and/or regulatory change.
Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 132. Adopt uniform and latest ASAP reporting standardRationale and evidence of effectiveness: Having uniform and modernized data collection standardscommon to all PDMPs would have many advantages, including the facilitation of cross-‐state datasharing, multistate data analyses, public health analyses, and collaborations with other organizationscollecting and making use of prescription history data, such as the Indian Health Service, Department ofDefense, VA, Medicaid, and Medicare. The Alliance of States with Prescription Monitoring ProgramsPMP Model Act 2010 Revision recommends that all PDMPs collect a minimum common set of data fields(ASPMP, 2010). Continuously updated standards for pharmacy data fields and formats, including thosereported to PDMPs, are set by the ASAP. The more recent standards make more data fields available,simplify data correction, and permit additional data reporting functionalities, such as tracking method ofpayment (see 5. Collect data on method of payment, below) (PDMP COE, NFF 3.1). Updating to morerecent ASAP standards may therefore improve the performance and effectiveness of individual PDMPs.A potential best practice is for all PDMPs to move to the latest standard, 4.2, released in 2011, and thenmove in concert to new versions as they are released. Under its Harold Rogers Grant Program, BJA givespriority consideration to PDMPs proposing to adopt the latest ASAP standard.Current adoption status: All PDMPs use ASAP standards, but adoption of the most current version bymany PDMPs has usually taken years. For example, in February 2012, of 40 operational PDMPs, 5 wereusing the 2005 version 3.0, 5 were using the 2007 version 4.0, 13 were using the 2010 version 4.1 (datacompiled by PDMP COE), and the 17 remaining PDMPs were using older versions.Barriers to adoption: Barriers to adoption include the need to change some states’ laws and/orregulations that identify a specific ASAP version, and the costs and staff time necessary to implementASAP upgrades for state PDMPs and for pharmacy software systems. Given their cumulative experiencein making system improvements, many PDMPs and pharmacies are becoming increasingly efficient inadopting new standards, so the cost of future upgrades will likely decrease.SummaryRationale: Uniform data standard may facilitate cross-‐state data sharing, analyses, and inter-‐‐organizational collaboration; more recent standards provide more complete data fields, improve errorcorrection, and provide additional reporting functionalities.Evidence of effectiveness: Case study, expert opinion.Current adoption status: Of 40 operational PDMPs (as of February 2012), 5 were using ASAP version 3.0,5 were using version 4.0, 13 were using version 4.1, and the 17 remaining PDMPs were using olderversions.Barriers to adoption: Upgrade costs, staff resources.
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