Health Information Technology and Doctor Shopping: A Systematic Review

Abstract

Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions. Health information technology (HIT) allows healthcare providers and patients to leverage records or shared information to improve effective care. Our research objective was to determine how HIT is being leveraged to control for doctor shopping. We analyzed articles that covered a 10-year time period from four databases and reported using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We compared intervention, study design, and bias, in addition to showing intervention interactions with facilitators, barriers, and medical outcomes. From 42 articles published from six countries, we identified seven interventions, five facilitator themes with two individual observations, three barrier themes with six individual observations, and two medical outcome themes with four individual observations. Multiple HIT mechanisms exist to control for doctor shopping. Some are associated with a decrease in overdose mortality, but access is not universal or compulsory, and data sharing is sporadic. Because shoppers travel hundreds of miles in pursuit of prescription drugs, data sharing should be an imperative. Research supports leveraging HIT to control doctor shopping, yet without robust data sharing agreements, the efforts of the system are limited to the efforts of the entity with the least number of barriers to their goal. Shoppers will seek out and exploit that organization that does not require participation or checking of prescription drug monitoring programs (PDMP), and the research shows that they will drive great distances to exploit this weakest link.

Mapping the research addressing prescription drug monitoring programs: A scoping review

“…Overall, half of the studies involved patients [9,18,22–24,26,27,32,34,36–38,41–43,45,46,48,50,53,54,59,62,63,65,66,71,73,75,77–80,84–86,88,90,93,95,97,98,100,101,104,105,108–110,115–118,121,123,125,130,131,134,140,144,146,147,149,151,152,154–156,158,159,161,163,165,167] and 47% included health‐care providers [11,19,20,25,29,30,33,35,37,39,40,43,44,49,51,54–61,67–69,71,72,74,76,80–83,87,91,93,94,96,102,103,106,111–114,119,120,122,124,125,127,128,130,132,133,136–139,141,143,145,147,148,150,153,157,160,162,165]. Some studies included both patient and provider populations [36, 37, 54, 59, 80, 93, 130, 147, 166].…”

“…For example, Martin et al [94] addressed barriers and facilitators to PDMP use. Only one study analysed data from 2020, and specifically investigated the control of doctor shopping through the use of health information technology [79]. This scoping review differs in that it includes the most up to date research inclusive of studies published in 2021, and provides a broader view compared with the narrower focus reported in previously published scoping studies.…”

“…The majority of the studies were quantitative (70%), with reviews (systematic, scoping and narrative) accounting for the next highest ranked study type (11%) [5,11,21,31,47,53,63,74,79,94,99,107,121,123,129,145,158], followed by qualitative studies (6.5%) [19,55,58,72,82,83,96,125,135,143]. Most of the remaining studies were mixed methods [39,49,51,97,119,122], program or education intervention evaluation [20,29,56], and quality improvement projects [93,137].…”

“…Facilitators to PDMP use. Mandated use was the main facilitator examined in the research (22%) [11,21,27,28,47,49,53,58,60,63,66,71,72,74,79,83,90,94,99,102,104,107,114,118,125,127,129,135,140,146,152,156,157], followed by perceived usefulness including workflow integration (16%), and training, education and outreach programs (15%). While registration was explored as a barrier, its role as a facilitator to PDMP use was also included in the research in 17 studies (11%).…”

Framework for Advancing Epidemiological Criminology Research on Prescription Drug Monitoring Programs

“…The fundamental challenge for identifying this behavior using PDMP data is that the presence of multiple provider episodes (MPEs), as it is frequently termed in the public health literature, does not always mean criminal intent. PDMPs have been demonstrated to dampen doctor shopping behavior but only under certain conditions (Kruse et al, 2020;Castillo-Carniglia et al, 2020). As MPEs become rarer, which they are according to the CDC (Strickler et al, 2020), predictive associations will likely diminish.…”