Prescription Drug Monitoring Programs - PDMP Center of Excellence

More documents

Recommendations

Info

Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 24For further discussion and recommendations for research on establishing valid criteria for questionableactivity, see Section V. Summary and Recommendations, below.SummaryRationale: Validated criteria for questionable activity are needed to target unsolicited reports andimprove measures of doctor shopping and other questionable activity.Evidence of effectiveness: Key stakeholder perceptions.Current adoption status: Variation in thresholds and other criteria used by states.Barriers to adoption: Lack of sufficient research to validate criteria.C. Conduct periodic analyses of possible questionable activityRationale: PDMP data are unique in providing estimates of possible doctor shopping and otherquestionable activity, either on the part of patients or prescribers. Such activity is a precursor tocontrolled substance diversion and abuse, and so is an indicator of a contributing cause of theprescription drug abuse epidemic. Since levels of questionable activity, such as the number of individualsmeeting criteria for doctor shopping (see B. Determine valid criteria for possible questionable activity,above), are affected by the use of PDMPs, they can also serve as indicators of theimpact of the PDMP and of program improvements, possibly providing evidence for PDMP effectiveness.Current adoption status and evidence of effectiveness: The Virginia PDMP found that the number ofindividuals meeting thresholds for possible doctor shopping (10x10 and 15x15 in a six-‐month period)declined following a large increase in data queries to the PDMP, in turn likely the result of improvedaccess to PDMP data (Virginia Prescription Monitoring Program, 2010). Declines in numbers of individualsmeeting doctor shopping thresholds subsequent to issuing unsolicited reports, as well as declines inprescribers, pharmacies, and dosage units for individuals reported on, have been observed in Wyomingand Nevada (PDMP COE, NFF 1.1, 2.5). This suggests that states, if they are not already doing so, shouldbe encouraged to conduct periodic threshold and other analyses to track trends in possible questionableactivity on the part of patients and prescribers that can then be correlated with PDMP utilization andreporting. PDMPs that are Harold Rogers grantees report such analyses every three months. Suchanalyses may provide evidence suggesting PDMP effectiveness that could be communicated tostakeholders and funders to build support for PDMPs. Developing standard analyses common to allPDMPs, e.g., using validated thresholds and/or criteria for questionable activity (see B. Determine validcriteria for possible questionable activity, above), would permit cross-‐state comparisons to helpevaluate program innovations and provide standard measures by which to gauge the impact of PDMPsover time.Barriers to adoption: Barriers to conducting periodic analyses of questionable activity include lack ofprogram resources to carry out analyses and the need for standard criteria to permit cross-‐statecomparisons.
Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 25SummaryRationale: Periodic analyses of rates of questionable activity track an indicator of possible substanceabuse and diversion, and can help assess the impact of the PDMP and program improvements.Evidence of effectiveness: Accumulated experience, key stakeholder perceptions.Current adoption status: Harold Rogers grantees and some other states conduct regular analyses.Barriers to adoption: Lack of program resources to conduct analyses, no standard criteria forquestionable activity.D. Conduct epidemiological analyses for use in surveillance, early warning, evaluation, andpreventionRationale: As part of their standard practice, PDMPs make reports on individual prescription historiesavailable to end users, but some also produce and disseminate other types of data analyses relevant topublic health objectives involving prescription drugs. Distributing such analyses, which ordinarily de-‐‐identify or encrypt patient and prescriber-‐specific information, may increase the impact of PDMPs.PDMP data can be analyzed by geographic area (county, zip code, pharmacy, town, etc.) and time periodto illuminate trends in both prescribing and questionable activity relevant to drug abuse surveillance andprevention efforts. Under its Harold Rogers Grant Program, BJA gives priority consideration to PDMPsproposing to share data and partner with researchers conducting epidemiological analyses concernedwith the prescription drug abuse epidemic.Evidence of effectiveness and current adoption status: Some states have conducted epidemiologicalanalyses of PDMP data for a variety of purposes. Maine’s PDMP provided data on controlled substanceprescribing patterns to the National Institute on Drug Abuse’s Community Epidemiological Work Group,which reports on emerging drug abuse trends at the state and city levels (personal communication), andresearchers have analyzed Maine PDMP data to describe trends in prescribing and questionable activity(Payne & Thayer, 2009). The South Carolina PDMP provided data to the PDMP COE by county and by agegroup on the prescribing of opioids; analyses identified an unexpected level of young opioid users in twomajor counties. This information, along with Wyoming PDMP data on the prevalence of doctor shoppingby age group, was provided to the U.S. Surgeon General’s 2011 Expert Panel on Prescription Drug Abusein Youth (Eadie, 2011, March). Similarly, the Massachusetts PDMP and Brandeis University researchershave produced geo-‐spatial analyses of rates of possible doctor shoppers. These analyses indicate thatcommunities with the highest rates also tend to have the highest concentrations of opioid overdosesand deaths (Carnevale & Associates and PDMP COE, 2010; Kreiner, 2011). More recent analyses indicatethat communities with high rates of questionable activity are at risk for subsequent increases in rates offatal and non-‐fatal opioid overdoses (Kreiner, 2012). Had these analyses been possible in prior years, theMassachusetts PDMP could have issued warnings before the overdoses and deaths became epidemic.Warnings could be sent to all community, state, and national stakeholders, including health carepractitioners, law enforcement agencies, educators, substance abuse prevention and treatmentorganizations, schools, parent-‐teacher organizations, religious organizations, and other groups.
Page 1 and 2: Prescription Drug MonitoringProgram
Page 3 and 4: Table of ContentsAcknowledgementsI.
Page 5 and 6: Prescription Drug Monitoring Progra
Page 27: Prescription Drug Monitoring Progra
Page 79 and 80:
Prescription Drug Monitoring Progra
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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?