Leading a Horse to Water

Abstract

Objectives Prescription Drug Monitoring Programs (PDMPs) can help inform patient management, coordinate care, and identify drug safety risks, abuse, or diversion. However, many clinicians are not registered to use these systems, and use may be suboptimal. We sought to describe outreach efforts in one state (Oregon); quantify uptake of system use; identify barriers; and identify potential system improvements. Methods Program reports of outreach efforts and operational metrics provided rates of registration and use. A statewide survey identified perceived barriers and potential improvements from users and non-users of the system. Results Even with extensive registration efforts, less than 25 percent of clinicians and pharmacists acquired PDMP accounts over 2 years of operation. Rapid increases in registration and use in 2013 corresponded to new requirements among large pharmacy chains that pharmacists register for and use the PDMP. Among surveyed PDMP non-users, nearly half were unaware they could register. Among users and non-users, over two-thirds indicated that time constraints were a major barrier and over half thought inability to delegate access was a major barrier. Desired improvements included linking state systems, faster entry of pharmacy data, and use of unique patient identifiers. Users also wanted better insurance coverage for mental health and addiction referrals. Discussion Increasing registration and use of PDMPs remains important. Clinician feedback indicates that program enhancements and healthcare system changes would facilitate using and responding to PDMP information. It appears premature to judge the efficacy of PDMPs until best practices for their use are identified and impacts are assessed.

Dental Opioid Prescribing Practices and Risk Mitigation Strategy Implementation: Identification of Potential Targets for Provider-Level Intervention

“…Multiple barriers to consistent prescriber PDMP use have been identified for other prescriber groups, including lack of awareness, accessibility, quality and interpretability of data, uncertainty regarding how to respond in instances of suspected diversion or abuse, fear of legal retribution, and privacy/data security concerns. 42 – 45 Whereas some states have enacted legislating mandating the use of a PDMP prior to prescribing, 41 PDMP use was not mandated for dentists in the current study. The overwhelming majority of dentists reported never using their PDMP because they were not aware it existed or did not know how to access it.…”

Plan Type and Opioid Prescriptions for Children in Medicaid

“…Second, studies show that when there are mandatory use policies for Prescription Drug Monitoring Programs (PDMPs) there is less dental opioid prescribing. 41 However, when PDMPs are voluntary, participation is low. 42 A third approach is policy guidelines that encourage providers to prescribe opioid alternatives like nonsteroidal anti-inflammatory drugs.…”

“…Hydrocodone was the most common opioid prescribed to Medicaid-enrolled children in our study (Appendix A, Supplemental Digital Content 1, http://links.lww.com/MLR/C186). Second, studies show that when there are mandatory use policies for Prescription Drug Monitoring Programs (PDMPs) there is less dental opioid prescribing 41. However, when PDMPs are voluntary, participation is low 42.…”

Health‐care practitioner use of prescription drug monitoring programs in clinical practice in Australia: A qualitative study

“…It is commonly understood that practitioner PDMP uptake and use along with the identification of associated barriers plays an important role in whether these programs will achieve their objectives [8]. PDMPs may be underutilised due to a number of barriers [8,10,12,[16][17][18]. Barriers to use have been investigated in an attempt to address practitioner uptake and optimise PDMP use [19,20].…”

“…Barriers to use have been investigated in an attempt to address practitioner uptake and optimise PDMP use [19,20]. Common-reported barriers include limited time and PDMP access, lack of systems integration and interstate data sharing and the literature reports opportunities for further research in this area [16,18,19].…”