Prescription Drug Monitoring Programs - PDMP Center of Excellence

More documents

Recommendations

Info

Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 20Current adoption status: Data quality standards and policies, and procedures in support of achievingacceptable data quality, differ among PDMPs and likely produce varying degrees of success in theirattainment.Barriers to adoption: Barriers to data quality improvement include the cost in staff time of surveyingcurrent practices, lack of data quality standards, and lack of resources needed to update data qualitysystems.SummaryRationale: Complete and accurate data can improve reporting, are important for prescribers andpharmacists making patient care decisions, and can help in detecting questionable activity.Evidence of effectiveness: Accumulated field experience, key stakeholder perceptions.Current adoption status: States vary in data quality practices.Barriers to adoption: Cost of surveying current practices, lack of standards, resources needed to updatedata quality systems.Data linking and analysisBest practices in PDMP data linking and analysis will permit better identification of unique individuals inPDMP data, development of standard analyses comparable across states, more reliable estimates ofquestionable activity, more appropriate and applicable epidemiological investigations, expedited andmore reliable analyses, and reports incorporating experienced user knowledge. Candidate practicesinclude actions to:A. Link records to permit reliable identification of individualsB. Determine valid criteria for possible questionable activityC. Conduct periodic analyses of possible questionable activityD. Conduct epidemiological analyses for use in surveillance, early warning, evaluation, andpreventionE. Develop automated expert systems to expedite analyses and reportsF. Record data on prescriber disciplinary status and patient lock-‐insA. Link records to permit reliable identification of individualsRationale and evidence of effectiveness: Reliable identification of unique individuals in PDMP databases,whether patients or prescribers, is vital for accurate analyses and reporting of questionable activity andprescribing trends. Although states have implemented a number of approaches to link patient records, todate, there has been neither a census taken of such approaches, nor an evaluation of their effectiveness.
Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 21Standard benchmarks for reliable record linking need to be identified against which different linkingalgorithms can be tested. Since the capability to link records belonging to an individual is critical toproviding accurate prescription information to all users and is essential for analyzing the impact ofPDMPs, e.g., measuring the level of questionable activity, this is an area deserving of close examinationfor developing evidence-‐based best practices. See Section V. Summary and Recommendations, below,for further discussion and recommendations.Current adoption status: Many states have developed electronic capabilities to link prescriptionsdispensed to what is likely to be a single individual in cases where the personal identifying informationvaries between records, e.g., the same address and prescriber but a differently spelled first name. Suchlinking is accomplished through vendor proprietary software, off-‐the-‐shelf software, or in-‐housedeveloped or modified software.Barriers to adoption: Barriers to adopting reliable record linking systems include lack of standardbenchmarks to assess linking algorithms and lack of resources to conduct research to develop standards.SummaryRationale: Reliable linking of records maximizes identification of unique individuals in PDMP data.Evidence of effectiveness: Key stakeholder perceptions.Current adoption status: States vary in whether and how records are linked.Barriers to adoption: Lack of resources to conduct needed research, no standard benchmarks to assesslinking algorithms.B. Determine valid criteria for possible questionable activityRationale and evidence for effectiveness: Despite the relatively widespread use of unsolicited reporting(see User access and report dissemination, E. Send unsolicited reports and alerts to appropriate users,below) on individuals exhibiting possible questionable activity (e.g., doctor shopping), there is littlecommonality in the criteria used by PDMPs to identify them. Validated and standardized criteria aretherefore needed to permit reliable identification of questionable activity within and acrossjurisdictions. Proactive reporting is also applicable to medical providers who, whether intentionally ornot, may be engaging in risky or illegal prescribing or dispensing behavior. Alerts concerning questionableactivity on the part of providers may be appropriately addressed to licensure boards, peer reviewcommittees, third-‐party payers, Centers for Medicare and Medicaid Services (CMS), and other bodies oragencies concerned or charged with monitoring medical practitioners. When analysis of PDMP dataidentifies probable criminal activity, such as prescribing by pill mills, referral to law enforcement agencieswould be appropriate. To guide such alerts, reliable criteria of questionable activity byproviders using PDMP and other data need research and development; see, for instance, DuBose et al.(2011).Several studies have attempted to shed light on criteria for identifying conditions and behaviors that putpatients at risk for prescription drug abuse. Patients who visit a few prescribers (two to five) in a yearseem not to be more at risk for opioid abuse than those using only one (Wilsey et al., 2011). Studying asample of insurance patients on whom they were able to obtain medical records, White et al. (2009)
Page 1 and 2: Prescription Drug MonitoringProgram
Page 3 and 4: Table of ContentsAcknowledgementsI.
Page 5 and 6: Prescription Drug Monitoring Progra
Page 23: Prescription Drug Monitoring Progra
Page 75 and 76:
Prescription Drug Monitoring Progra
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
show all

Prescription Drug Monitoring Programs - PDMP Center of Excellence

Create successful ePaper yourself

Delete template?

Save as template?