Prescription Drug Monitoring Programs - PDMP Center of Excellence

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Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 30filled less than 10 days apart and from a different prescriber. (Presentation by Scott Best, Clinical NurseAdvisor, Washington State Health Care Authority at CDC Medicaid Patient Review and Restriction ExpertPanel Meeting, August 27-‐28, 2012, Atlanta, GA). Without the batch transfer of PDMP data, this activitywould not have come to light.PDMPs should be surveyed to document the types of PDMP report customization they currently offer, aswell as any innovative reporting functions. To gauge effectiveness, process outcome data on how changesin reporting affect utilization should be sought from PDMPs as well as survey data from end users on theusefulness of customized reports or functionalities. Such information could help determine which of thesemight be recommended as PDMP best practices in reporting.Barriers to adoption: Barriers to optimizing reports for end users include the costs of designing andimplementing customized report types as well as the need to survey end users on what report types andfunctionalities would be most useful.SummaryRationale: Meeting end-‐user needs by optimizing reporting helps incentivize use of PDMP data,increasing PDMP impact.Evidence of effectiveness: Accumulated experience, key stakeholder perceptions.Current adoption status: A few PDMPs.Barriers to adoption: Development and implementation costs of new reporting functions andcustomizations.C. Integrate PDMP reports with health information exchanges, electronic health records,and pharmacy dispensing systemsRationale: Integrating PDMP data retrieval with health information exchanges (HIE), electronic healthrecords (EHR), and pharmacy dispensing systems should help reduce the time and effort needed forprescribers and their staff and for pharmacists to access a patient’s prescription history. The Office of theNational Coordinator for Health Information Technology (ONC) at the Department of Health and HumanServices, in collaboration with MITRE Corporation, is leading an effort to develop and test a methodologyfor seamless transfer of PDMP data to prescribers, dispensers, and emergency departments beforepatients are seen by physicians and to pharmacies before dispensing. This effort, called “EnhancingAccess to PDMPs,” plans to utilize systems in which health care providers and third-‐‐ party payers confirmpatients' eligibility for third-‐party payment prior to patients being treated. The ultimate goal is to providesecure PDMP data in real time to electronic records systems such that medical providers havecontinuous access to prescription history information vital to safe prescribing of controlled substances.Current adoption status and evidence for effectiveness: Two pilot projects are planned by the ONC, onein Ohio using a “drug-‐risk indicator” in the EHR, and one in Indiana involving emergency departmentstaff access to prescription information via EHRs. These efforts, and other initiatives by states toincorporate PDMP data into HIE/EHR, need to be documented and evaluated to determine theirfeasibility and which of them show promise as models for other states. In advance of full integration
Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 31with health information systems, intermediate steps to integrate the PDMP into the provider’s workflowcan be explored, such as instituting batch reporting on patients scheduled for upcoming visits (see B.Optimize reporting to fit user needs, above) and sending unsolicited reports or alerts to prescribers anddispensers that prompt them to consult the PDMP (see D. Send unsolicited reports and alerts toappropriate users, below).Barriers to adoption: Barriers to integrating PDMP reports with health information exchanges andelectronic medical records include the need to develop and test data systems, and concerns about datasecurity and patient confidentiality.SummaryRationale: Integrating PDMP data with HIEs, EHRs and pharmacy dispensing systems facilitatesprescriber and dispenser access to PDMP data.Evidence of effectiveness: Key stakeholder perceptions.Current adoption status: None.Barriers to adoption: Lack of resources needed to develop and test data systems, concerns about datasecurity, and patient confidentiality.D. Send unsolicited reports and alerts to appropriate usersRationale: Some PDMPs, in addition to supplying reports when requested or downloaded by end users(solicited reports), also send out unsolicited reports based on PDMP data suggesting questionableactivity such as doctor shopping or inappropriate prescribing such as by pill mills. Recipients ofunsolicited reports sent by states include prescribers, pharmacists, investigative agencies, and licensureboards. As a minimum requirement for states to receive PDMP funding under NASPER, SAMHSAestablished that PDMPs must provide unsolicited reports to medical practitioners (SAMHSA,2005). Unsolicited reports can serve several functions: inform prescribers and pharmacists that patientsmay be abusing or diverting controlled substances; help prescribers make better decisions aboutprescribing controlled substances, thus improving patient care; and inform potential end users aboutthe PDMP and its value. Reports sent to investigative agencies and licensure boards can assist intargeting drug diversion reduction efforts and ensuring safe, effective, and legal medical practice.Evidence for effectiveness: Nevada initiated its PDMP in 1997 by sending unsolicited reports toprescribers about possible doctor shoppers. These reports quickly generated interest in the PDMP amongprescribers, sparking further requests for data (solicited reports) (PDMP COE, NFF 2.5). Analyses ofNevada PDMP data from 1997 to 2002 indicate that individuals for whom unsolicited reports were sentexhibited declines in the average number of dosage units and numbers of pharmacies and prescribersvisited subsequent to the reports. This suggests the reports may have influenced prescribing by providerstreating these patients. Similarly, analyses of data from the Wyoming PDMP suggest that unsolicitedreports helped to raise awareness of the PDMP, leading to greater requests for data, with asubsequent decline in numbers of individuals identified in the PDMP database who met doctor shoppingthresholds (PDMP COE, NFF 1.1).
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