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Corry B, Cremer LJ, Donnelly C, Sargent WM, Mells J, Kelly R, Reynolds J, Young LD. Changes in opioid prescribing and prescription drug monitoring program utilization following electronic health record integration-Massachusetts, 2018. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:380-386. [PMID: 38407391 PMCID: PMC11147687 DOI: 10.1093/pm/pnae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE In this study, we explored key prescription drug monitoring program-related outcomes among clinicians from a broad cohort of Massachusetts healthcare facilities following prescription drug monitoring program (PDMP) and electronic health record (EHR) data integration. METHODS Outcomes included seven-day rolling averages of opioids prescribed, morphine milligram equivalents (MMEs) prescribed, and PDMP queries. We employed a longitudinal study design to analyze PDMP data over a 15-month study period which allowed for six and a half months of pre- and post-integration observations surrounding a two-month integration period. We used longitudinal mixed effects models to examine the effect of EHR integration on each of the key outcomes. RESULTS Following EHR integration, PDMP queries increased both through the web-based portal and in total (0.037, [95% CI = 0.017, 0.057] and 0.056, [95% CI = 0.035, 0.077]). Both measures of clinician opioid prescribing declined throughout the study period; however, no significant effect following EHR integration was observed. These results were consistent when our analysis was applied to a subset consisting only of continuous PDMP users. CONCLUSIONS Our results support EHR integration contributing to PDMP utilization by clinicians but do not support changes in opioid prescribing behavior.
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Affiliation(s)
- Brian Corry
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Laura J Cremer
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Christopher Donnelly
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Wesley M Sargent
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Jamie Mells
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Rodd Kelly
- Massachusetts Department of Public Health, Massachusetts Prescription Monitoring Program, Bureau of Health Professions Licensure, Boston, MA 02108, USA
| | - Joshua Reynolds
- Massachusetts Department of Public Health, Massachusetts Prescription Monitoring Program, Bureau of Health Professions Licensure, Boston, MA 02108, USA
| | - Leonard D Young
- Massachusetts Department of Public Health, Massachusetts Prescription Monitoring Program, Bureau of Health Professions Licensure, Boston, MA 02108, USA
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Hoppe D, George Liu C, Khalil H. Health-care practitioner use of prescription drug monitoring programs in clinical practice in Australia: A qualitative study. Drug Alcohol Rev 2023; 42:1647-1657. [PMID: 37402606 DOI: 10.1111/dar.13711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Prescription drug monitoring programs (PDMP) are electronic databases used by prescribers and pharmacists to monitor the use of high-risk prescription medications subject to extramedical use. This study aimed to explore how Australian pharmacists and prescribers are using PDMPs in practice and to gain an understanding of barriers to tool use, as well as practitioner recommendations to increase tool usability and uptake. METHODS Semi-structured interviews were conducted with pharmacists and prescribers who use a PDMP (n = 21). The interviews were audio-recorded, transcribed and thematically analysed. RESULTS The four themes that emerged were: (i) PDMP notifications combined with practitioner clinical judgement guide PDMP usability; (ii) practitioners use PDMPs to facilitate patient and practitioner communication; (iii) workflow systems integration impacts tool usability; and (iv) optimising PDMP information and data access including practitioner-tool engagement to improve tool uptake and usability. DISCUSSION AND CONCLUSIONS Practitioners appreciate the value of PDMP information support for clinical decisions and patient communication. However, they also acknowledge the challenges to tool use and recommend improvements including enhanced workflow, systems integration, optimisation of tool information and national data sharing. Practitioners provide an important perspective on PDMP use in clinical practice. The findings can be drawn on by PDMP administrators to improve tool usefulness. Consequently, this may lead to an increase in practitioner PDMP use and optimise the delivery of quality patient care.
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Affiliation(s)
- Dimi Hoppe
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Chaojie George Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Hoppe D, Liu C, Khalil H. Barriers and facilitators related to healthcare practitioner use of real time prescription monitoring tools in Australia. Front Public Health 2023; 11:1175791. [PMID: 37771830 PMCID: PMC10522831 DOI: 10.3389/fpubh.2023.1175791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Real time prescription monitoring tools have been implemented in Australia to address the growing concerns of drug misuse, drug-related mortality and morbidity. The objective of this pilot study is to investigate the barriers and facilitators related to healthcare practitioner use of real time prescription monitoring tools. Methods An online survey was distributed to Australian prescribers and pharmacists who use a real time prescription monitoring tool. Data analysis included descriptive statistics, chi-square tests and multivariate logistic regression analyses. Results A total of 102 questionnaires were analyzed. Practitioners mainly agreed that the tool was easy to use (n = 64; 66.7%) and access (n = 56; 57.7%), and the data was easy to interpret (n = 77; 79.4%). Over half agreed that they wanted training to guide clinical actions (n = 52; 55.9%) and clinical guidelines or guidance on what to do with the RTPM findings (n = 51; 54.8%). Prescribers were more likely to report difficulties with workplace access to a computer or the internet (n = 7; 21.2%) compared with pharmacists (n = 6; 9.2%; p = 0.037). Practitioners working in community settings (n = 59; 57.9%; p = 0.022) and those with 1-10 years practice experience (n = 45; 44.2%; p = 0.036) were more likely to want training to guide clinical actions in response to RTPM information. Conclusion This is the first known study to investigate the barriers and facilitators related to practitioner use of RTPM tools in Australia. The results from this study can inform further research to gain an understanding of healthcare practitioners use of RTPM tools, and how to minimize barriers and optimize use for the essential delivery of quality healthcare.
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Affiliation(s)
- Dimi Hoppe
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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St. Marie BJ, Witry MJ, Reist JC. Barriers to Increasing Prescription Drug Monitoring Program Use: A Multidisciplinary Perspective. Comput Inform Nurs 2023; 41:556-562. [PMID: 36728156 PMCID: PMC10349893 DOI: 10.1097/cin.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prescription drug monitoring programs are implemented through individual state policies and are one solution to curb the opioid crisis. The objectives of this study are to: (1) describe the multidisciplinary experiences using this program in practice; (2) identify limitations of the program and the desired features for improvement; and (3) characterize expectations for improved access when prescription drug monitoring programs are embedded in the electronic health record. A qualitative descriptive study design used semistructured interviews of 15 multidisciplinary healthcare providers. Textual data were analyzed using content analysis. Results showed the prescription drug monitoring program was helpful to decision-making processes related to opioid prescribing and referral to treatment; there were barriers limiting healthcare providers' use of the prescription drug monitoring program; preferences were delineated for integrating prescription drug monitoring program into electronic health record; and recommendations were provided to improve the program and increase use. In conclusion, the prescription drug monitoring program was viewed as useful in making strides to reduce the impact of inappropriate opioid prescribing in our country. By engaging a multidisciplinary group of healthcare providers, solutions were offered to improve the interface and function of the prescription drug monitoring program to assist in increasing use.
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Sharp LK, Solanki P, Boyer T, Vivo A, Kale I, Hughes AM, Gibson G, Jurasic MM, Evans CT, Suda KJ. A qualitative exploration of dentists' opioid prescribing decisions within U.S. veterans affairs facilities. Pain 2023; 164:749-757. [PMID: 35984367 PMCID: PMC10026830 DOI: 10.1097/j.pain.0000000000002759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT The U.S. Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States and provides dental care to approximately one-half million veterans annually. In response to the opioid crisis, the VA released several opioid risk mitigation strategies. Although opioid prescribing by VA dentists has decreased on the whole, the implementation experiences at the level of dentists remains unclear. Our objective was to explore the barriers and facilitators that affect opioid decision making for management of acute dental pain among VA dentists. Dentists practicing in the VA facilities with the highest and lowest volume of opioid prescriptions were recruited. Standardized qualitative interviews by telephone followed a semistructured guide designed around the Capability (C), Opportunity (O), Motivation (M), and Behaviour (B) model. Audio recordings were transcribed and independently double-coded using NVivo to identify potential targets for future guideline-based opioid interventions. Of 395 eligible general and specialty dentists, 90 (24.8%) completed an interview representing 33 VA facilities. Opportunities for prescribing opioids included 1) completion of dental procedures associated with acute dental pain, 2) caring for patients who presented with existing dental pain, and 3) responding to patient opioid requests. Capabilities included using resources (eg, electronic medical records), clinical judgement (eg, evaluation of medical history including medication use), communication skills, and ability to screen for opioid misuse. Motivation themes focused on alleviating patients' acute dental pain. Barriers and facilitators of opioid prescribing varied across facilities. The results can offer intervention targets for continued opioid risk mitigation efforts.
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Affiliation(s)
- Lisa K. Sharp
- Department of Pharmacy Systems Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Pooja Solanki
- Center of Innovation for Complex Chronic Healthcare, Edward Hines JR VA Medical Center, Hines, IL, United States
| | - Taylor Boyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Amanda Vivo
- Center of Innovation for Complex Chronic Healthcare, Edward Hines JR VA Medical Center, Hines, IL, United States
| | - Ibuola Kale
- Center of Innovation for Complex Chronic Healthcare, Edward Hines JR VA Medical Center, Hines, IL, United States
| | - Ashley M. Hughes
- Department of Biomedical and Health Information Sciences, College of Allied Health, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, United States
| | - Gretchen Gibson
- Veterans Health Administration, Office of Dentistry, Washington DC, United States, United States
| | - M. Marianne Jurasic
- VA Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, United States
| | - Charlesnika T. Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines JR VA Medical Center, Hines, IL, United States
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Picco L, Lam T, Xia T, Nielsen S. Factors associated with prescription drug monitoring program utilisation: a cross-sectional survey of community pharmacists. Int J Clin Pharm 2023; 45:421-429. [PMID: 36528707 PMCID: PMC9759276 DOI: 10.1007/s11096-022-01523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMP) are databases which collect prescribing and dispensing information for high-risk medicines, and are one approach to mitigate prescription opioid-related risks. AIM To examine correlates of PDMP use under voluntary and mandatory conditions, among a representative sample of community pharmacists in Victoria, Australia. METHOD An online anonymous survey was conducted and collected data in relation to pharmacist and pharmacy characteristics, comfort in performing certain tasks, PDMP training and the frequency of PDMP use under voluntary and mandatory conditions. Multivariate logistic regression models were performed to determine the effect of each covariate on voluntary and mandatory PDMP use. RESULTS In total, 265 pharmacists participated (response rate 47%). Under voluntary conditions, a quarter of pharmacists (24.9%) used the PDMP all the time, while half (51.7%) used the PDMP all of the time, once mandated. Pharmacies that stocked naloxone (OR: 1.96; 95% CI 1.11-3.45) and pharmacists that had attended formal PDMP training (OR: 1.78; 95% CI 1.05-3.05), were significantly associated with regular PDMP use under voluntary conditions. Under mandatory conditions, increased odds of PDMP use were associated with pharmacies that stocked naloxone (OR: 1.88; 95% CI 1.06-3.34). Pharmacists working in regional and rural areas had significantly lower odds (OR: 0.35; 95% CI 0.20-0.63) of always using the PDMP, as did pharmacists with > 15 years' experience (OR: 0.24; 95% CI 0.11-0.51) once use was mandated. CONCLUSION Given that PDMP utilisation was slower or less regular amongst pharmacists located in regional and rural areas, pharmacists with more years of experience and those not already supplying naloxone, targeted training aimed at these sub-populations may be beneficial.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
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Strombotne KL, Legler A, Minegishi T, Trafton JA, Oliva EM, Lewis ET, Sohoni P, Garrido MM, Pizer SD, Frakt AB. Effect of a Predictive Analytics-Targeted Program in Patients on Opioids: a Stepped-Wedge Cluster Randomized Controlled Trial. J Gen Intern Med 2023; 38:375-381. [PMID: 35501628 PMCID: PMC9060407 DOI: 10.1007/s11606-022-07617-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Risk of overdose, suicide, and other adverse outcomes are elevated among sub-populations prescribed opioid analgesics. To address this, the Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM)-a provider-facing dashboard that utilizes predictive analytics to stratify patients prescribed opioids based on risk for overdose/suicide. OBJECTIVE To evaluate the impact of the case review mandate on serious adverse events (SAEs) and all-cause mortality among high-risk Veterans. DESIGN A 23-month stepped-wedge cluster randomized controlled trial in all 140 VHA medical centers between 2018 and 2020. PARTICIPANTS A total of 44,042 patients actively prescribed opioid analgesics with high STORM risk scores (i.e., percentiles 1% to 5%) for an overdose or suicide-related event. INTERVENTION A mandate requiring providers to perform case reviews on opioid analgesic-prescribed patients at high risk of overdose/suicide. MAIN MEASURES Nine serious adverse events (SAEs), case review completion, number of risk mitigation strategies, and all-cause mortality. KEY RESULTS Mandated review inclusion was associated with a significant decrease in all-cause mortality within 4 months of inclusion (OR: 0.78; 95% CI: 0.65-0.94). There was no detectable effect on SAEs. Stepped-wedge analyses found that mandated review patients were five times more likely to receive a case review than non-mandated patients with similar risk (OR: 5.1; 95% CI: 3.64-7.23) and received more risk mitigation strategies than non-mandated patients (0.498; CI: 0.39-0.61). CONCLUSIONS Among VHA patients prescribed opioid analgesics, identifying high risk patients and mandating they receive an interdisciplinary case review was associated with a decrease in all-cause mortality. Results suggest that providers can leverage predictive analytic-targeted population health approaches and interdisciplinary collaboration to improve patient outcomes. TRIAL REGISTRATION ISRCTN16012111.
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Affiliation(s)
- Kiersten L Strombotne
- Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA.
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA.
| | - Aaron Legler
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA
| | - Taeko Minegishi
- Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Jodie A Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Menlo Park, CA, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Veterans Health Administration, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical School, Palo Alto, CA, USA
| | - Elizabeth M Oliva
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Menlo Park, CA, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Veterans Health Administration, Menlo Park, CA, USA
| | - Eleanor T Lewis
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Menlo Park, CA, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Veterans Health Administration, Menlo Park, CA, USA
| | - Pooja Sohoni
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Menlo Park, CA, USA
| | - Melissa M Garrido
- Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA
| | - Steven D Pizer
- Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA
| | - Austin B Frakt
- Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
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Witry M, Marie BS, Reist J. Provider perspectives and experiences following the integration of the prescription drug monitoring program into the electronic health record. Health Informatics J 2022; 28:14604582221113435. [PMID: 35829729 DOI: 10.1177/14604582221113435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prescription drug monitoring programs (PDMPs) are a public health tool for prescribers and pharmacists to monitor controlled substance use at the patient level. The objectives of this study were to (1) assess attitudes about the PDMP and perceived changes in experience and decision-making following integration into the electronic health record (EHR), and (2) identify barriers to optimal PDMP use and user recommendations for improvement. This descriptive study used an electronic survey to obtain feedback from prescribers and pharmacists at a single academic medical center. Descriptive statistics were calculated, and textual data were analyzed. Of 1480 PDMP users 208 responded (14.1%). Responses demonstrated the integration of the PDMP into the EHR simplified log-in and access to PDMP information resulting in more frequent access and perceived improvement of care quality. Barriers included technical issues accessing the PDMP within the EHR and the lack of integration of other state PDMPs. Overall, the benefit of integrating the PDMP into the EHR was positive but largely limited to streamlining log-in and patient selection. Recommendations for improvement include addressing technological issues and education on PDMP interpretation and integrating new features that may modify prescribing, referral, and co-prescribing behaviors.
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Affiliation(s)
- Matthew Witry
- Pharmacy Practice and Science, 15509The University of Iowa College of Pharmacy, Iowa City, LA, USA
| | - Barbara St Marie
- College of Nursing, 16102The University of Iowa College of Nursing, Iowa City, LA, USA
| | - Jeffrey Reist
- Pharmacy Practice and Science, 15509The University of Iowa College of Pharmacy, Iowa City, LA, USA
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Al-Astal AEY, Sodhi K, Lakhani HV. Optimization of Prescription Drug Monitoring Program to Overcome Opioid Epidemic in West Virginia. Cureus 2022; 14:e22434. [PMID: 35371719 PMCID: PMC8941824 DOI: 10.7759/cureus.22434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/08/2022] Open
Abstract
The development of the Prescription Drug Monitoring Program (PDMP) led to an innovation in the healthcare organization system (HCOs). The PDMP system has been utilized in different states at various organizational levels in an effort to achieve improved health outcomes, reduce the number of prescription drug overdoses, and lighten the economic burden that follows. However, during the implementation of PDMP, there were several barriers and limitations that were discovered. Those barriers impeded the process of utilization of PDMP, such as the complex user interface and lack of training for healthcare providers. The purpose of this paper was to examine the advances and limitations in the utilization and implementation of PDMP in the US healthcare industry and develop strategies for effective use of PDMP in West Virginia. The qualitative part of this paper was a literature review. The paper referred to several peer-reviewed studies and research articles from several reliable resources, which were reached by databases or Google Scholar. A total of 44 articles were reviewed for this study. The implementation of the PDMP was influenced by benefits and barriers. This article reviewed several studies in general that demonstrated positive outcomes from the implementation of PDMP, including a reduced number of prescription drug overdoses, coordinated care for patients, and improved health outcomes. However, the barriers and limitations were not neglected, which mainly include integration of PDMP into the electronic health record (EHR) system, lack of training for the providers, and lack of basic standards for the use of PDMP. Although the new health reforms encouraged the adaption of PDMP among providers, data reporting and data interpretation still remain major concerns for assessing the health outcomes of PDMP implementation.
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Hoppe D, Karimi L, Khalil H. Mapping the research addressing prescription drug monitoring programs: A scoping review. Drug Alcohol Rev 2022; 41:803-817. [PMID: 35106867 DOI: 10.1111/dar.13431] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
ISSUES Prescription drug monitoring programs are a harm minimisation intervention and clinical decision support tool that address the public health concern surrounding prescription drug misuse. Given the large number of studies published to date and the ongoing implementation of these programs, it is important to map the literature and identify areas for further research to improve practice. APPROACH A scoping review was undertaken to identify the research on prescription drug monitoring programs published between January 2015 and April 2021. KEY FINDINGS A total of 153 citations were included in this scoping review. The majority of the studies originated from the USA and were quantitative. Results on program effectiveness are mixed and mainly examine their association with opioid-related outcomes. Unintended consequences are revealed in the literature and this review also highlights barriers to program use. IMPLICATIONS Overall, findings are mixed despite the large number of studies published to date. Mapping the literature identifies priority areas for further research that can advise policymakers and clinicians on practice improvement. CONCLUSION Results on prescription drug monitoring program effectiveness are mixed and mainly examine their association with opioid-related outcomes. This review highlights barriers to prescription drug monitoring program effectiveness related to program use and system integration. Further research is needed in these areas to improve prescription drug monitoring program use and patient outcomes.
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Affiliation(s)
- Dimi Hoppe
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Keller MS, Jusufagic A, Nuckols T, Needleman J, Heilemann M. How Do Clinicians of Different Specialties Perceive and Use Opioid Risk Mitigation Strategies? A Qualitative Study. Subst Use Misuse 2021; 56:1352-1362. [PMID: 34027814 PMCID: PMC8667780 DOI: 10.1080/10826084.2021.1926514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In response to the opioid crisis, states and health systems are encouraging clinicians to use risk mitigation strategies aimed at assessing a patient's risk for opioid misuse or abuse: opioid agreements, prescription drug monitoring programs (PDMPs), and urine drug tests (UDT). Objective: The objective of this qualitative study was to understand how clinicians perceived and used risk mitigation strategies for opioid abuse/misuse and identify barriers to implementation. Methods: We interviewed clinicians who prescribe opioid medications in the outpatient setting from 2016-2018 and analyzed the data using Constructivist Grounded Theory methodology. Results: We interviewed 21 primary care clinicians and 12 specialists. Nearly all clinicians reported using the PDMP. Some clinicians (adopters) found the opioid agreement and UDTs to be valuable, but most (non-adopters) did not. Adopters found the agreements and UDTs helpful in treating patients equitably, setting limits, and having objective evidence of misuse; protocols and workflows facilitated the use of the strategies. Non-adopters perceived the strategies as awkward, disruptive to the clinician-patient relationship, and introducing a power differential; they also cited lack of time and resources as barriers to use. Conclusions: Our study demonstrates that clinicians in certain settings have found effective ways to implement and use the PDMP, opioid agreements, and UDT but that other clinicians are less comfortable with their use. Administrators and policymakers should ensure that the strategies are designed in a way that strengthens the clinician-patient relationship while maximizing safety for patients and that clinicians are adequately trained and supported when introducing the strategies.
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Affiliation(s)
- Michelle S. Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alma Jusufagic
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Teryl Nuckols
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jack Needleman
- Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California
| | - MarySue Heilemann
- UCLA School of Nursing, University of California-Los Angeles, Los Angeles, California
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Andrea SB, Gilbert TA, Morasco BJ, Saha S, Carlson KF. Factors Related to Prescription Drug Monitoring Program Queries for Veterans Receiving Long-Term Opioid Therapy. PAIN MEDICINE 2020; 22:1548-1558. [DOI: 10.1093/pm/pnaa386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
Objective
State prescription drug monitoring programs (PDMPs) identify controlled medications dispensed across providers and systems. Department of Veterans Affairs (VA) policy requires electronic health record documentation of PDMP queries at least annually for VA patients receiving controlled medications; however, queries are not uniformly conducted. We examined factors associated with PDMP queries for veterans receiving long-term opioid therapy.
Methods
Veterans with a VA provider who received long-term opioid therapy between August 2015 and August 2016 within a four-state region were identified; 9,879 were due for a PDMP query between August 2016 and February 2017. Likelihood of veterans’ PDMP queries during this follow-up period was modeled as a function of patient, provider, and facility characteristics of interest in mixed-effects modified Poisson models estimating relative risk and 95% confidence intervals. Multivariable models controlled for potential confounders identified through the use of directed acyclic graphs.
Results
PDMP queries were documented for 62.1% of veterans that were due for a PDMP query. Veterans were more likely to be queried if they were Hispanic or if they received methadone, had average daily milligram morphine equivalents >20, or received urine drug screening during the studied period. Veterans were less likely to be queried if they had a rural address, mail order medication, or cancer diagnosis. Likelihood of PDMP queries was also lower for veterans whose opioid-prescribing provider was an oncologist or working in a low-complexity facility.
Conclusions
Adherence to PDMP query policy within the VA varied by patient, clinician, and facility factors. Mechanisms to standardize the conduct of PDMP queries may be needed.
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Affiliation(s)
- Sarah B Andrea
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Tess A Gilbert
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Benjamin J Morasco
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
| | - Somnath Saha
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathleen F Carlson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
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13
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Abuhammad S, Alzoubi K, Khabour O, Mukattash T. Jordanian National Study of Nurses' Barriers and Predictors for Research Utilization in Clinical Settings. Risk Manag Healthc Policy 2020; 13:2563-2569. [PMID: 33209066 PMCID: PMC7669527 DOI: 10.2147/rmhp.s279043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background The nurses are the healthcare providers and researchers in the health institutions. Investment in the research potential of nurses will ultimately benefit society. The purpose of this study was to survey nurses regarding barriers to participating in research studies. Methods This was a cross-sectional descriptive study using electronic surveys sent by email, and social media groups (WhatsApp). A total of 447 nurses agreed to participate in this study. Barriers were measured using the Barriers of Research Utilization (BRU) Scale. Results More than half (53.3%) of the participants perceived the barriers to be high, whereas a small fraction (8.9%) perceived them as low. Barriers related to the organization scored the highest (P<0.01) compared to the other domains (nurse, innovation, and communication). The regression analysis model showed that age, working experience, and nationality were associated with barriers to participate in research (P<0.05). Conclusion More than half of the nurses in Jordan perceived barriers to participating in research studies to be high. The barriers associated with the organization had more influence. A comprehensive approach should be developed to boost research utilization among nurses by overcoming the barriers identified in the current study.
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Affiliation(s)
- Sawsan Abuhammad
- Department of Maternal and Child Health, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Omar Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
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