Doctor Shopping Research Articles

Experiences of people with unexplained hearing concerns seeking hearing healthcare in the United States.

Up to 10% of adults seeking hearing healthcare for significant hearing concerns have diagnostic test results that indicate normal hearing. Knowledge of the interactions between patients with unexplained hearing concerns and hearing healthcare providers is minimal. In this study, we explored what themes emerged when individuals with unexplained hearing concerns discuss their experiences seeking hearing healthcare. We employed a prospective, cross-sectional qualitative design with semi-structured interviews. Fifteen adults who had sought professional hearing evaluations in the United States due to hearing concerns but had audiological testing that indicated hearing within normal limits, and no other medical explanation for their hearing concerns participated in the study. Saturation of themes was reached by Interview #2, suggesting sufficient sampling. Thematic analysis revealed 3 themes from the interviews: (1) dismissive healthcare providers, (2) misalignment of patient concerns and assessment protocols, and (3) doctor shopping. These findings highlight the need for improved care for patients with unexplained hearing concerns. Clinicians could help improve care provision for patients with unexplained hearing concerns, despite a lack of professional guidance on diagnostic tests or treatment recommendations, by soliciting, listening to, and trusting patient experiences as they seek support for their hearing concerns.

Inputs of pharmacoepidemiology in addictovigilance: How do they fit together?

The French Addictovigilance Network has been using data from the French Heath insurance since the late 1990s to assess prescription drug abuse. In this narrative review, we illustrate the inputs of pharmacoepidemiology in addictovigilance based on the experience of the French Addictovigilance Network. The review focuses on pharmacoepidemiology using the French National Health Data System. We propose three examples: the MEGADOSE study, which aimed to conduct the first nation-wide, systematic, repeated assessment of doctor shopping; the DANTE study, which aimed to assess trends in analgesic use, focusing on the prevalence of use and the demographic profiles of analgesic users by age and sex; and the ZORRO study, which aimed to assess the impact of secure prescription forms on the use of zolpidem and other sedatives. These examples show how pharmacoepidemiology fits in the multifaceted monitoring conducted by the French Addictovigilance Network and complements the other data sources of this framework. This approach improves signal detection, confirmation, and quantification. It also makes it possible to overcome the limitations of each data source taken individually.

The Extent of Delay in Diagnosis, Treatment and their Associated Factors among Tuberculosis Patients Attending Government Hospitals of Rishikesh, Uttarakhand: A Cross-Sectional Study.

"Tuberculosis (TB) remains a major public health problem" worldwide, affecting almost all age groups. "Early diagnosis and prompt treatment are essential to significantly reducing the TB burden." However, a significant proportion of cases remain undiagnosed and untreated, which plays a vital role in the transmission of the disease and severity of the illness in the community in most developing countries. This study aimed to assess "the extent of delay in diagnosis and treatment of TB patients" and to identify the major factors associated with such delays (whether patient or health system-related) among TB patients in Rishikesh. This descriptive cross-sectional study was conducted in Rishikesh Town, Dehradun District, Uttara khand, India. Total of 130 newly diagnosed TB patients were recruited as study participants who attended the government hospitals of Rishikesh, All India Institute of Medical Sciences, Rishikesh and S P S Government Hospital, Rishikesh. A universal sampling technique was used in this study. The mean age of the study participant was 36.75 (Standard Deviation (SD), 17.6), and the median age was 34 years. Of the patients, 64.6% were men, and 35.4% were women. The extent of various delays, such as patient delay (median 16 days), diagnostic delay (median 78.5 days), treatment delay (median 4 days), health system delay (43 days), and total delay (median 81 days). The misconception of any chronic disease may lead to a false diagnosis or long treatment for symptomatic relief; the absence of proper diagnostic tests and doctor shopping could be the reasons for the prolonged diagnostic delay. Therefore, by strengthening the collaboration between private and public practitioners in order to meet the expectations of the Government of India to achieve the goals of the "National Strategic Plan for ending TB" in India by providing good quality care for all patients.

Exploring Opioid Prescription Patterns and Overdose Rates in South Carolina (2017-2021): Insights into Rising Deaths in High-Risk Areas.

With opioid overdose rates on the rise, we aimed to develop a county-level risk stratification that specifically focused on access to medications for opioid use disorder (MOUDs) and high overdose rates. We examined over 15 million records from the South Carolina Prescription Tracking System (SCRIPTS) across 46 counties. Additionally, we incorporated data from opioid treatment programs, healthcare professionals prescribing naltrexone, clinicians with buprenorphine waivers, and county-level overdose fatality statistics. To assess the risk of opioid misuse, we classified counties into high-risk and low-risk categories based on their prescription rates, overdose fatalities, and treatment service availability. Statistical methods employed included the two-sample t-test and linear regression. The t-test assessed the differences in per capita prescription rates between high-risk and low-risk counties. Linear regression was used to analyze the trends over time. Our study showed that between 2017 and 2021, opioid prescriptions decreased from 64,223 to 41,214 per 100,000 residents, while fentanyl-related overdose deaths increased by 312%. High-risk counties had significantly higher rates of fentanyl prescriptions and relied more on out-of-state doctors. They also exhibited higher instances of doctor shopping and had fewer medical doctors per capita, with limited access to MOUDs. To effectively combat the opioid crisis, we advocate for improved local healthcare infrastructure, broader treatment access, stricter management of out-of-state prescriptions, and vigilant tracking of prescription patterns. Tailored local strategies are essential for mitigating the opioid epidemic in these communities.

Drug Diversion: Could be a Serious Concern in Global Healthcare System

Prescription drug diversion is a significant $25 billion-a-year problem in the US. Diversion can occur at any stage of the medicine delivery process, from manufacturing to the patient. Common diversion methods include illegal selling by doctors/pharmacists, “doctor shopping,” theft/forgery of prescriptions, and burglaries/thefts. Emerging diversion methods include theft by healthcare workers, fraud involving insurance, and theft from medicine cabinets. The main sources of diverted medications are at the practitioner-patient level, such as through “doctor shopping” and friends/family sharing prescriptions. Diversion from healthcare settings like hospitals accounts for a smaller proportion, though the exact extent is difficult to quantify. Some diversion occurs through theft from pharmacies, manufacturers, and supply chain points, but this makes up a relatively small percentage. Healthcare providers who engage in drug diversion have been linked to infectious disease outbreaks in hospitals, exposing patients to pathogens like hepatitis C. Intelligent systems and machine learning can help rapidly detect diversion anomalies. Comprehensive solutions are needed, including policy reforms, communication strategies, and a public health approach.

Is There Uniformity in the Diagnosis of Learning Disability Globally?

Learning disabilities (LDs) are a group of neurodevelopmental deficits that negatively affect the acquisition, organization, retention, comprehension, or application of age appropriate knowledge. Persons with LD lead a subsidized quality of life, especially in academic/vocational and psychosocial domains. A certificate issued by the medical boards at a state or district level is required to avail benefits such as scribes or relaxations. This may be done through a series of assessments by psychologists, special educators, or other health-care professionals. The authors aim to understand if uniformity exists in the assessment methods used for the diagnosis of LD globally and to prepare a gap analysis for the same. A systematic review was performed on English literature articles published from January 2005 to August 2023. Full-text studies reporting assessment and diagnostic methods of LD were included. A total of 1246 records were identified through a manual search of an electronic database. Seven duplicates were removed and 1174 studies were excluded based on the relevance by screening titles, abstracts, and full texts. Sixty-five studies were included and analyzed. The authors found a lack of uniformity in this diagnostic protocol, leading to uncertainty in disability certification, doctor shopping, and additional stress for the patients, as well as added burden on the government. Identification of LD requires a multistep assessment process with culturally relevant tools and norms and the participation of a multidisciplinary team of experts.

Challenging Disability Discrimination in the Clinical Use of PDMP Algorithms.

State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm-generated information and risk scores motivates clinicians to refuse to treat-or to inappropriately treat-vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act.

Use and misuse of psychoactive medicines: a descriptive cross-sectional study in a densely populated region of Portugal.

Although psychoactive medicines (PMed) are needed in several psychiatric conditions, their use and misuse bear risks. We aimed at estimating the prevalence of PMed use and misuse. Data on all PMed prescribed in 2017 and dispensed in community pharmacies of the Lisbon and Tagus Valley region of Portugal (ARSLVT) were extracted from ARSLVT medicines' dispensing database. For 21 PMed among prescription opioids, benzodiazepines and z-drugs (BZDR), antidepressants (AD) and anticonvulsants (AC), we estimated the number of users of each PMed, and assessed PMed misuse by a set of proxy indicators for studying this practice: chronic use (use of ≥180 DDD during the study period) of PMed intended for short-term treatments, concomitant use of several PMed, in particular if involving long-term (≥ 30 days) opioid analgesic (OA) use, and doctor shopping (patients consulting several physicians in order to have access to a quantity higher than intended by each prescriber). Data were analysed using descriptive statistics and hypothesis testing, and multivariate logistic regression was used to explore potential factors affecting long-term concomitant treatment of chronic OA with other PMed. PMed use prevalence was 21.7%: 6.6% for OA, 12.7% for benzodiazepines (BZD), 5.3% for AD and 2.8% for AC. BZDR were mainly prescribed in primary care and OA in hospital outpatients. Chronic use of PMed was observed in 25%, especially with sertraline and buprenorphine for opioid use disorder (long-term treatment), and lorazepam (short-term treatment). About 56.6% of OA chronic users were long-term concurrent users with other PMed, mainly BZDR. Risk of abuse was low for BZDR, whilst four opioids had meaningful doctor shopping indicators - fentanyl, opioid use disorder buprenorphine, morphine and hydromorphone. BZD are the main PMed used in ARSLVT, often chronically, especially lorazepam. Prevalence of OA use is low, although with higher risk of misuse than BZDR. Concomitant use of several PMed is frequent.

Prescription high-risk polysubstance use among opioid maintenance treatment patients.

Among individuals receiving buprenorphine or methadone as opioid maintenance treatment (OMT), concomitant use of other central nervous system depressants, including prescription drugs, can increase risk of overdose. We aimed to 1) determine the prevalence of use of high-risk prescription drugs (opioid analgesics, benzodiazepines, benzodiazepine-related drugs, and gabapentinoids) among OMT patients, 2) calculate its associations with different mental health and pain-related diagnoses, and 3) compare prevalence of concomitant use with the general population. A national sample comprising all individuals filling at least one prescription of OMT drugs in Norway in 2019 was formed. Healthcare registry data were linked to investigate high-risk prescription drug use and different diagnoses. We calculated one-year prevalence of use, amount dispensed in defined daily doses (DDDs), and the number of prescribers for the different high-risk prescription drugs. Logistic regression was used to determine associations (adjusted odds ratios; aOR, 95% confidence intervals (CIs)) between diagnoses and use. Prevalence of use was calculated both in the OMT patient sample and the general population. Among the OMT patient sample (n=7,299), 47.6% (n=3,476) filled prescriptions for benzodiazepines. For each high-risk prescription drug group, there was a median of 1-2 prescribers. Musculoskeletal diagnoses were the strongest factor for concomitant high-risk prescription drug use for both males (aOR 3.23, CI: 2.72-3.85) and females (aOR 3.07, CI: 2.42- 3.90). The 1-year prevalence of benzodiazepine use was 11.4 times higher for males and 7.1 times higher for females in OMT than the general population. The amount in DDDs was higher for every drug for OMT patients than the general population, particularly for benzodiazepines. OMT patients frequently filled prescriptions for high-risk drugs, and in higher dosages than the general population. However, we found little evidence of 'doctor shopping.' Given that these prescription drugs carry overdose risk, particularly when combined with OMT drugs, our findings emphasize the continued need for education and caution to both prescribers and patients on their concomitant use with OMT.

Association of State Drug Laws with Nonmedical Use of Prescription Medications in Adolescents.

The aim of the study is to examine the associations between mandatory access prescription drug monitoring programs (PDMPs), pain management clinic (PMC) laws, and doctor shopping (DS) laws with adolescent nonmedical use of prescription medications (NUPM). We linked 2011-2015 Youth Risk Behavior Survey data on 364,103 adolescents across 40 states with PDMP, PMC laws, and DS laws. We conducted a 2-way fixed effects logistic regression model to examine the associations between state drug laws and adolescent self-reported NUPM. We found some evidence that implementation of a mandatory access PDMP was associated with a decrease in nonmedical use of prescription drugs at the P = 0.079 level (average marginal effect: -0.017, 95% confidence interval = -0.036 to 0.002), while there were no associations with the implementation of PMC and DS laws. Our findings suggest that current state drug laws to combat NUPM are inadequate for adolescents.

Evaluation and management of the dysesthetic patient.

Dysesthesia is symptomatology that includes but is not limited to sensations of pain, burning, crawling, biting, numbness, piercing, pulling, cold, shock-like, pulling, wetness, and heat. These sensations can cause significant emotional distress and functional impairment in affected individuals. Although some cases of dysesthesia are secondary to organic etiologies, most cases exist without an identifiable infectious, inflammatory, autoimmune, metabolic, or neoplastic process. Ongoing vigilance is required for concurrent or evolving processes, including paraneoplastic presentations. Elusive etiologies, unclear treatment regimens, and stigma leave patients and clinicians with a difficult path forward marked by "doctor shopping," lack of treatment, and significant psychosocial distress. We address this symptomatology and the psychosocial burden that often comes with it. Although notoriously labeled as "difficult to treat," dysesthesia patients can be effectively managed, making life-changing relief possible for patients.

Using pharmacy surveillance information systems to monitor the dispensing practice of under-controlled drugs: A qualitative study on necessities, requirements, and implementation challenges

The food and drug administration (FDA) usually monitors drug dispensing practices to manage their resources. Despite advances in information technology, traditional paper-based processes are used for this purpose in several low and middle income countries. This study aimed to determine the necessities, requirements, and implementation challenges of using pharmacy surveillance information systems (PSISs) to monitor the dispensing practice of under-controlled drugs and substances. This qualitative study was conducted in 2021. The population of the study was 16 FDA managers and pharmacy owners and pharmacy information systems (PIS) users in Iran. First, data collection was performed through open-ended, semi-structured interviews. Then, a focus group including experts in pharmacology, health information management, medical informatics, and information technology reviewed and confirmed the necessities, requirements, users' information needs, and implementation challenges of the PSIS. The results of the study showed that improving safety, conducting utilization management, reducing doctor shopping, and supporting patients were the most important reasons to monitor the dispensing practice of under-controlled drugs. The participants believed that the electronic monitoring of the dispensing of under-controlled drugs is essential and can increase the accuracy, timeliness, and ease of performing relevant processes. Based on the participants’ opinions, registering the data related to patients, prescribers, prescriptions, and pharmacies is necessary. The system should have functionalities to prevent illegal events and generate timely and updated reports. Resistance of stakeholders and shortage of infrastructure were identified as the main challenges for the implementation. Improving safety and supporting patients necessitate monitoring the dispensing practice of under-controlled drugs. To monitor this important practice, using a PSIS is necessary and it can support and facilitate the related processes.

Adaptive interventions for opioid prescription management and consumption monitoring.

While opioid addiction, treatment, and recovery are receiving attention, not much has been done on adaptive interventions to prevent opioid use disorder (OUD). To address this, we identify opioid prescription and opioid consumption as promising targets for adaptive interventions and present a design framework. Using the framework, we designed Smart Prescription Management (SPM) and Smart Consumption Monitoring (SCM) interventions. The interventions are evaluated using analytical modeling and secondary data on doctor shopping, opioid overdose, prescription quality, and cost components. SPM was most effective (30-90% improvement, for example, prescriptions reduced from 18 to 1.8 per patient) for extensive doctor shopping and reduced overdose events and mortality. Opioid adherence was improved and the likelihood of addiction declined (10-30%) as the response rate to SCM was increased. There is the potential for significant incentives ($2267-$3237) to be offered for addressing severe OUD. The framework and designed interventions adapt to changing needs and conditions of the patients to become an important part of global efforts in preventing OUD. To the best of our knowledge, this is the first paper on adaptive interventions for preventing OUD by addressing both prescription and consumption. SPM and SCM improved opioid prescription and consumption while reducing the risk of opioid addiction. These interventions will assist in better prescription decisions and in managing opioid consumption leading to desirable outcomes. The interventions can be extended to other substance use disorders and to study complex scenarios of prescription and nonprescription opioids in clinical studies.

Prégabaline misuse : Doctor shopping or pharmacist shopping and the impact of tightened prescribing restrictions ?

Prégabaline misuse : Doctor shopping or pharmacist shopping and the impact of tightened prescribing restrictions ?

Repeated Doctor Shopping in Functional Abdominal Pain Patient and Its Impact: A Case Report

Doctor-shopping involves visiting multiple doctors with the same health problem and is often observed in outpatient clinics.[1] Patients visit more doctors when they have a chronic disease or a drug addiction and their health problem remains unresolved despite receiving treatment.[2] The provider-patient relationship is essential to treatment of patient. If patient is visiting multiple doctors at same time without any previous records and even not disclosing previous checkups leads to repeated prescription of medication, increased drug dose consumption and increased healthcare cost as well. Here we report a case of 54 year female with chronic functional abdominal pain with once to twice weekly checkups at different hospital and with different specialist consultations. Keywords: doctor shopping, healthcare cost, drug abuse

Prevalence of andRisk Factors for Prescription Opioid Misuse, Abuse, Diversion and Doctor Shopping in Japan: A Survey Study.

IntroductionOpioid use disorder is a global problem. Although opioid analgesics are prescribed less frequently in Japan than in many other countries, the rate of aberrant prescription opioid-taking behaviors in Japan is unknown.MethodsAn internet survey was conducted to estimate the prevalence of and risk factors for prescription opioid misuse, abuse, diversion and doctor shopping in Japanese subjects with chronic pain who had been prescribed opioid analgesics. ResultsThe proportion of respondents (n = 387) who reported opioid misuse was 45.5% (95% confidence interval [CI]: 40.4–50.6); rates were: 24.6% (95% CI: 20.3–29.2) for abuse; 15.0% (95% CI: 11.6–19.0) for diversion; and 10.6% (95% CI: 7.7–14.1) for doctor shopping. Aberrant prescription opioid-taking behaviors were higher in participants with chronic post-cancer treatment pain (misuse, 64.2%; abuse, 52.2%) or chronic cancer pain (misuse, 57.4%; abuse, 26.2%) than in those with chronic noncancer pain (misuse, 37.8%; abuse, 17.0%). Younger age, male sex, smoking, habitual drinking, diagnosis of psychiatric disease, use of opioids other than tramadol, and use of opioids for chronic post-cancer treatment pain and chronic cancer pain were identified as risk factors for aberrant prescription opioid-taking behaviors.ConclusionEven in Japan, which has not experienced the surge in opioid consumption documented in other countries, aberrant prescription opioid-taking behaviors were observed. When prescribing opioid analgesics, universal precautions should always be taken for both cancer and non-cancer patients.Trial RegistrationUMIN000041788.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00409-6.

Yonder: Drunkorexia, dosette boxes, doctor shopping, and slums.

Yonder: Drunkorexia, dosette boxes, doctor shopping, and slums.

Healthcare Chain Network Framework for Monitoring and Verifying Pharmaceutical Supply Chain

Prescription drug abuse and doctor shopping are major problems in the healthcare field that have led to a significant number of deaths as a consequence of drug misuse. Doctors prescribe too much fentanyl, Demerol, and sleeping pills, along with anxiety medications, that are legal and frequently abused. In order to combat prescription drug abuse, it is imperative to develop an efficient monitoring and identification system. Blockchain technology is a promising solution to tracking prescriptions because of its decentralization and auditability, which allow medical records to be more secure as well as more reliable. Blockchain technology can help ensure the authenticity, integrity, and transparency of drug distribution between pharmacies and doctors. In this paper, we aim to develop a system of managing the integrity of the drug supply chain by integrating Hyperledger Fabric blockchain technology with Interplanetary File System (IPFS). Because of its secure encryption framework and anti-fraud and anti-forgery measures, it has prevented prescription abuse. A smart health care ecosystem is created by using smart contracts to track drugs on the blockchain. In addition, by using this approach we are able to recognize and track drugs that may be misused by individuals who shop for doctors and hop between pharmacies. The cryptographically safe and reliable framework created by Healthcare Chain can be used by doctors, pharmacists, and patients to improve how opioid prescriptions and medication are administered.

Modeling Patients' Illness Perception and Equilibrium Analysis of Their Doctor Shopping Behavior

When a patient's illness perception is inconsistent with a doctor's diagnosis, she may seek opinions from multiple doctors without referrals, a behavior called doctor shopping. In this study, we model and derive patients' optimal doctor shopping decisions. After each visit, patients update their beliefs about their health status following the Bayes' rule. We show that the patients' doctor shopping decisions are critically affected by the diagnosis accuracy, the relative value of identifying a severely ill patient, and the cost per visit. We examine how the patients' doctor shopping behavior affects social welfare from two aspects, namely, an objective one that accesses whether doctor shopping improves the judgment accuracy regarding the patient's health status, and a subjective one concerning whether doctor shopping relieves patients' anxiety. We find that allowing patients to conduct doctor shopping exacerbates the system congestion ( congestion effect), but it can help those patients who have decided to join obtain a higher reward ( reward effect). There exists a diagnosis accuracy threshold above which allowing doctor shopping incurs a welfare loss and below which allowing doctor shopping improves welfare. Moreover, this diagnosis accuracy threshold increases as patients become more pessimistic or hold more diverse initial illness perceptions. The objective welfare maximization prefers a higher doctor shopping rate than the subjective welfare maximization does only when the value of identifying a severely ill patient is high enough, which may help explain why doctor shopping is encouraged for the critical illness such as cancer.

Effects of ‘doctor shopping’ behaviour on prescription of addictive drugs in Sweden

Free choice of health care providers is aimed to improve the quality of health care by increasing both access to it and the competition between providers. However, it may also give patients possibilities for doctor shopping (DS) behaviour, i.e., visiting different providers to receive illicit drug prescriptions. Abuse of prescribed addictive drugs is a growing problem worldwide and is associated with increased mortality, lower quality of life and other problems on both the individual and societal level. We study DS behaviour for three categories of addictive drugs – opioid painkillers, benzodiazepine anxiolytics, and z-hypnotic sleeping drugs, in the outpatient care sector in Västerbotten County, Sweden. Our dataset contains all drug prescriptions purchased by the residents of Västerbotten in the period from January 2014 to April 2016 (approximately 160,000 observations). To identify signs of addictive prescription drugs abuse by DS, we analyse overlapping prescriptions. We use ‘Defined Daily Doses' (DDDs), which is the average treatment dose of a specific drug per day for adults, as a proxy for the treatment duration. To control for medically legitimate overlaps, we compare overlapping prescriptions within a clinic with overlapping prescriptions between different clinics. Our empirical results suggest that there is a significant and positive relationship between the number of overlapping doses and the number of unique providers in the overlap. More specifically, we find that visiting different providers on average gives patients up to three additional DDDs per day. This is three times higher than the standard treatment dose. We discuss policy implications in the concluding discussion.