Utilization Of Prescription Drug Monitoring Programs Research Articles

Changes in opioid prescribing and prescription drug monitoring program utilization following electronic health record integration-Massachusetts, 2018.

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. 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. 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. Our results support EHR integration contributing to PDMP utilization by clinicians but do not support changes in opioid prescribing behavior.

Prescription drug monitoring program (PDMP) utilization and outcomes within the West Palm Beach Veterans Affairs (VA) healthcare system.

Prescription drug monitoring programs (PDMPs) can identify patients at risk of controlled substance (CS) polypharmacy and accidental poisoning. A retrospective pre-/post-intervention review of a random sample of provider notes with documentation of PDMP outcomes was completed before and after the enactment of a Florida law mandating PDMP queries. West Palm Beach Veterans Affairs Health Care System, which provides inpatient and outpatient services. Reviewed a random sample of 10 percent of progress notes documenting PDMP outcomes between September and November 2017 and the same timeframe of 2018. Florida enacted a law in March 2018 requiring PDMP queries to be completed for all new and renewed CS prescriptions. The primary outcome was to compare PDMP utilization and prescribing decisions based on query results before and after the enactment of the law. The number of progress notes documenting PDMP queries increased by over 350 percent from 2017 to 2018. In 2017 and 2018, 30.6 percent (68/222) and 20.8 percent (164/790) of PDMP queries found non-Veterans Affairs (VA) CS prescriptions, respectively. Providers decided to avoid prescribing CS prescriptions in 23.5 percent (16/68) of patients with non-VA CS prescriptions found in 2017 and 11 percent (18/164) in 2018. Overlapping or unsafe combinations were identified in 10 percent (7/68) of queries with non-VA prescriptions found in 2017 and 14 percent (23/164) in 2018. Mandating PDMP queries resulted in an increase in the total number of queries, positive findings, and overlapping CS prescriptions. Outcomes of PDMP mandate impacted prescribing by discontinuation and avoidance of CS initiation in 10-15 percent of patients.

Primary Care Implementation of a Mandatory Prescription Drug Monitoring Program in New York City.

The ways in which prescription drug monitoring programs (PDMPs) have been integrated into clinical practice remain understudied, and research into PDMP implementation in states where PDMP use by providers is mandated remains scant. This qualitative study describes how use of a state-mandated PDMP influenced clinical practice and opioid analgesic prescribing. We conducted face-to-face, in-depth interviews with 53 New York State-licensed primary care physicians who reported that they currently prescribed opioid analgesic medication, including those providers who reported consistent use of the PDMP (n = 38) in this sample. We used a thematic analytic approach to identify patterns of PDMP implementation into practice following enactment of the New York State legislative usage mandate. Among physicians who consistently used the PDMP, we found two distinct groups: (1) physicians who reported no change in their clinical practice and (2) physicians who acknowledged changes to both clinical practice and administrative management. In the latter group, most physicians felt the PDMP had benefited their patient relationships by fostering dialogue around patient substance use; however, some used the PDMP to dismiss patients from care. Findings suggest that increased education for providers relating to judicious prescribing, opioid use disorder, and best practice for PDMP utilization are needed.

Primary care provider perspectives on and utilization of a mandatory prescription drug monitoring program in New York City.

The ways in which prescription drug monitoring programs (PDMPs) have been integrated into primary care practice remain understudied, and research into physician utilization of PDMPs in states where PDMP use is mandated remains scant. To characterize primary care physician perspectives on and utilization of a mandatory PDMP in New York City. We conducted face-to-face, in-depth interviews with primary care physicians who reported that they currently prescribed opioid analgesic medication. We used a thematic analytic approach to characterize physician perspectives on the PDMP mandate and physician integration of mandatory PDMP use into primary care practice. Primary care providers demonstrated a continuum of PDMP utilization, ranging from consistent use to the specifications of the mandate to inconsistent use to no use. Providers reported a range of perspectives on the purpose and function of the PDMP mandate, as well as a lack of clarity about the mandate and its enforcement. Findings suggest a need for increased clinical and public health education about the use of PDMPs as clinical tools to identify and treat patients with potential substance use disorders in primary care.

Opioid Prescribing After Implementation of Single Click Access to a State Prescription Drug Monitoring Program Database in a Health System's Electronic Health Record.

To determine the effect of one-click integration of a state's prescription drug monitoring program (PDMP) on the number of PDMP searches and opioid prescriptions, stratified by specialty. Our large health system worked with the state department of public health to integrate the PDMP with the electronic health record (EHR), which enabled providers to query the data with a single click inside the EHR environment. We evaluated Schedule II or III opioid prescriptions reported to the Massachusetts PDMP 6 months before (November 15, 2017-May 15, 2018) and 6 months after (May 16, 2018, to November 16, 2018) integration. Search counts, prescriptions, patients, morphine milligram equivalents, as well as prescriber specialty were compared. There were 3,185 unique prescribers with a record of a Schedule II and/or III opioid prescription in both study periods that met inclusion criteria. After integration, the number of PDMP searches increased from 208,684 in the pre-integration phase to 298,478 searches in the post-integration phase (+43.0%). The number of opioid prescriptions dispensed decreased by 4.8%, the number of patients receiving a prescription decreased by 5.1%, and the mean morphine milligram equivalents (MMEs) per prescriber decreased by 5.4%. There were some notable specialty-specific differences in these measures. Integration of the PDMP into the EHR markedly increased the number of searches but was associated with modest decreases in opioids prescribed and patients receiving a prescription. Single click EHR integration of the PDMP, if implemented broadly, may be a way for states to significantly increase PDMP utilization.

Prescription drug monitoring programs in community pharmacy: An exploration of pharmacist time requirements and labor cost

ObjectiveTo (1) measure the average time community pharmacists require to query prescription drug monitoring program (PDMP) reports, and (2) estimate pharmacist labor costs associated with PDMP use. DesignThis exploratory project consisted of an observational time study followed by analysis of existing PDMP data sets. Data collected included time spent by pharmacists in Final Verification of controlled substance prescriptions (CSPs), and whether or not they queried the PDMP. Zip code level PDMP query rates and prescription volume of opioid and benzodiazepines (O&BZD) were linked to time-study results to calculate cost estimates of pharmacist labor. Setting and participantsCommunity pharmacists in Connecticut were observed and timed in their usual pharmacy setting as they verified CSPs. Deidentified PDMP data were obtained from the Connecticut Prescription Monitoring and Reporting System. Outcome measures(1) The time required by community pharmacists to query their PDMP in prescription filling workflow, and (2) the estimated labor costs associated with variable PDMP utilization rates. ResultsBetween November 2018 and January 2019, 9 pharmacists in 4 independent community pharmacies were observed verifying 53 CSPs. Pharmacists spent more time verifying CSPs when they queried the PDMP versus when they did not query the PDMP (106 ± 66 seconds vs. 28 ± 27 seconds; p < 0.01). Between June 2016 and May 2017, community pharmacists in 24 community pharmacies in 4 represented zip codes queried the PDMP for 11% (n = 19,074) of CSPs dispensed, costing an estimated $24,769 in pharmacist labor. To meet a 100% PDMP query rate for O&BZDs alone, an additional 3735 hours of pharmacist labor ($224,100) would be required. ConclusionPharmacists require considerably more time to verify CSPs when they query PDMPs. This extra time requirement may challenge community pharmacy operating costs, and also impose time pressures on community pharmacists.

Provider Prescription Drug Monitoring Program Utilization and Self-Auditing-A Pilot Study.

Alabama has the highest prescription rate in the country. The national incidence of overdose deaths from prescription opioids exceeds the combined death rates from heroin and cocaine overdose. Monitoring prescription access should be an essential activity among providers and can be used to protect patient health and well-being. Prescription drug monitoring programs (PDMPs) are tools that assist in diminishing opioid therapy risks such as diversion, abuse, overdose, and death. The purpose of the study was to examine the effects of an educational intervention on opioid prescriptive rates, frequency of self-auditing and days of opioid supply among healthcare providers. The anticipated goal of the project was that rates and days of supply for opioid prescriptions would decrease. A pretest-posttest design was used to assess a sample of 21 DEA licensed providers who attended a PDMP presentation and conducted a self-audit using the PDMP. Analysis showed that 81% of the participants had never conducted a self-audit prior to the intervention. Self-report data indicated that 85.7% of the providers planned to increase their self-auditing use postintervention and 14.3% planned to make no changes to their current use of the PDMP. Among those who prescribed opioids, the range of monthly prescriptions written was 3-142 preintervention (M = 32.28, SD = 41.04) and 3-149 postintervention (M = 32.26, SD = 43.32). Analysis also found the days of opioid supply prescribed were also high. In both cases, these numbers were correlated to patient census. The PDMP is an effective surveillance tool that provides aggregate data to state public health officials. For a PDMP to be effective, it must be used by prescribing providers. While the anticipated goal for this study was not achieved, the PDMP is an effective surveillance tool for monitoring the controlled substance prescription histories of patients. Using the PDMP before prescribing can aid providers in distinguishing those who legitimately have a need from those who may be seeking to misuse the medications. Additionally, use of a PDMP can provide aggregate data to state public health officials so that education programs, for practitioners and patients, can be developed.

126 The Effect of Prescription Drug Monitoring Program Electronic Medical Record Integration on Prescription Drug Monitoring Program Utilization and Opioid Prescribing

Prescription drug monitoring programs (PDMPs) are state-based databases that report patients’-controlled substance prescription histories to providers. Use of PDMPs prior to writing an opioid prescription is mandated in over half of all states. However, PDMP data frequently must be obtained by accessing a Web portal which is external to a hospital’s electronic medical record (EMR). The goal of this study was to determine the effect of implementation of direct, one-click, PDMP integration into a health system’s EMR on the number of queries and opioid prescriptions overall and specifically by emergency medicine prescribers (based on self-reported specialty). This was a study in the state of Massachusetts. One-click integration with the PDMP was introduced in a large health system EMR, which includes 9 EDs, including 2 at large academic centers and 7 at community hospitals. One-click integration of the PDMP began on May 16, 2018. The pre-intervention study period was November 15, 2017 to May 15, 2018, and the post-intervention period was May 16, 2018 to November 15, 2018. National Provider Identifier (NPI) numbers for all providers in the studied health system who wrote at least one opioid prescription during the study period were provided to the state PDMP. For each of these prescribers, the number of searches, reported schedule II and III opioid prescriptions, and the average of the total morphine milligram equivalents (MMEs) per patient was compiled before and after integration began. State PDMP data indicate that there were 332,748 searches before vs. 470,984 searches after integration (+41.5% change). Numbers of opioid prescriptions filled were 207,978 before vs. 202,053 after integration (-2.8% change). Amongst emergency medicine prescribers, there were 8,868 searches before vs. 16,682 searches after integration (+88.1% change). The numbers of filled opioid prescriptions by emergency physicians were 5,800 before vs. 5,621 after (-3.1% change). The average total MME per patient across all specialties was 1,493 mg before integration and 1,425 mg after integration (-4.6% change). For emergency medicine prescribers, the average MME per patient was 137 mg before integration and 113 mg after (-17.4% change). A one-click integration of PDMP into an EMR markedly increases the search rate but has a negligible effect on the overall numbers of prescriptions for schedule II and III opioids that are filled.

Perceptions and Utilization of Prescription Drug Monitoring Programs: A Survey of ACOG members [1Q

INTRODUCTION: ACOG Committee Opinion 711 addresses opioid use in pregnancy and recommends utilization of Prescription Drug Monitoring Programs (PDMPs) before prescribing opioids to any patient. According to the US Centers for Disease Control and Prevention, PDMPs (electronic databases that track controlled substance prescriptions) can inform clinical practice and are primary prevention tools for drug abuse/diversion and neonatal abstinence syndrome (NAS). An increasing number of states mandate PDMP use; however, little is known about how specific physician specialties perceive and use PDMPs. The purpose of this study was to query ACOG member perceptions and utilization of their state PDMP. METHODS: ACOG District XII Committee on Health Care for Underserved Women distributed a voluntary anonymous email survey to 5,000 ACOG members (adjusted participants n=1,470, minus unread/bounced/opt-out). The survey instrument was developed by an OB/GYN and health services researcher workgroup to assess perceptions and utilization of PDMPs. Adjusted response rate=27% (n=397). RESULTS: Most (78%) were registered with their PDMP and 52% agreed that ...mandating physician use of the PDMP was a “good idea.” Most respondents agreed that the PDMP is a primary prevention tool for drug abuse/diversion (70%), addiction (68%), and/or doctor shopping (63%), but few agreed that it was an NAS primary prevention tool (22%). Respondents use the PDMP for patients currently using opioids (33%), and for patients suspected of drug abuse (29%). In qualitative responses, some reported frustration with PDMPs. CONCLUSION: ACOG members are diverse in their perceptions regarding the utility and purpose of PDMPs. Increased education is needed regarding clinical utility of PDMPs.

Obstetrician/Gynecologist Perception of Prescription Drug Monitoring Program Effectiveness [15I

INTRODUCTION: Prescription drug monitoring programs (PDMPs) are primary prevention tools designed to reduce rising rates of substance use disorders (SUD) and sequelae such as neonatal abstinence syndrome. Evidence regarding OB/GYN perceptions of PDMPs, which may impact PDMP utilization, is unavailable. This study examines perceived PDMP effectiveness among OB/GYNs compared to primary care physicians (PCPs). METHODS: In the absence of national-level data, independent surveys of PDMP users in Florida, Kentucky, and California were evaluated based on a Likert-type item to assess perception of PDMP effectiveness in reducing prescription drug abuse and diversion. Response distributions of OB/GYNs versus PCPs were compared using chi square tests for each state. RESULTS: In Florida, there were 41 OB/GYN and 511 PCP respondents; Kentucky, 46 OB/GYNs and 265 PCPs; and California, 41 OB/GYNs and 162 PCPs. In each state OB/GYNs viewed PDMPs as less effective, positive, or useful compared to PCPs (p≤0.01, all states). Florida: 64.1% OB/GYN vs. 83.7% PCP “agree positive impact”. Kentucky: 45.0% OB/GYN vs. 68.5% PCP “effective”. California: 73.2% OB/GYN vs. 86.4% PCP “useful”. CONCLUSION: These results suggest OB/GYNs view their state's PDMP as less effective than do PCPs. These perceptions may present barriers to PDMP utilization and decrease opportunities for SUD interventions. Outreach and guidelines to OB/GYNs regarding PDMP effectiveness as a SUD screening tool would be helpful. Further engagement of all prescribers, including OB/GYNs, is needed to inform future strategies, programs, policies and PDMP features to increase PDMP effectiveness.

Attitudes and self-reported practices of orthopedic providers regarding prescription opioid use.

Orthopedic surgeons are the third-highest opioid prescribers in the United States. Their prescribing practices can significantly affect the quantity of unconsumed opioids available to fuel the current opioid epidemic. The aim of this study was to identify prescribing patterns and knowledge gaps among orthopedic providers for targeted future interventions and investigation. An online survey describing six common orthopedic surgical scenarios was distributed electronically to determine opioid type and quantity prescribed at discharge, medication disposal instructions, and the use of prescription drug monitoring programs (PDMPs) in the prescription writing process. Tertiary care academic hospitals. Orthopedic physicians and mid-level providers practicing at Johns Hopkins Medical Institutions and University of Maryland Medical System. Of 179 providers contacted, 127 (71 percent) completed the survey. Quantity of opioid prescribed, utilization of PDMPs, and provision of opioid disposal instructions. While statistically significant associations were identified between quantity of opioid prescribed and surgical procedure, for five of six scenarios 95 percent of respondents recommended prescribing >55 oxycodone 5 mg pill equivalents (PEs) at discharge. An inverse correlation between years of clinical practice and mean number of PEs prescribed was observed. Fewer than 40 percent of respondents modified prescribing when presented with clinically relevant changes in scenario (history of depression or drug abuse). Over 60 percent of respondents do not use PDMPs, and 79 percent do not provide opioid disposal instructions. Our findings support a need for targeted education to mitigate the role of orthopedic postoperative prescribing practices on the current opioid abuse epidemic.

Perception of prescription drug monitoring programs as a prevention tool in primary medical care.

Prescription drug monitoring programs (PDMPs) are primary prevention tools to reduce substance use disorders (SUD) and sequelae. Evidence regarding perceptions of PDMPs from different primary care providers, which may impact PDMP utilization for women, is unavailable. To examine perceived PDMP effectiveness among obstetrician-gynecologists (OB/GYNs) compared to primary care physicians (PCPs). Independent surveys of PDMP users in Florida, Kentucky, and California were evaluated based on a Likert-type item to assess perception of PDMP effectiveness in reducing prescription drug abuse and diversion. Response distributions of OB/GYNs versus PCPs were compared using chi-square tests. In Florida, there were 41 OB/GYN and 511 PCP respondents; Kentucky, 46 OB/GYNs and 265 PCPs; and California, 41 OB/GYNs and 162 PCPs. In each state OB/GYNs viewed PDMPs as less effective, positive, or useful compared to PCPs (p ≤ 0.01, all states): Florida: 64.1% OB/GYN vs. 83.7% PCP "agree positive impact"; Kentucky: 45.0% OB/GYN vs. 68.5% PCP "effective". California: 73.2% OB/GYN vs. 86.4% PCP "useful". These results suggest OB/GYNs view their state's PDMP as less effective than do PCPs, which may present barriers to PDMP utilization and decrease opportunities for SUD interventions. Engagement of all healthcare team members is needed to inform future strategies and policies to increase PDMP effectiveness.

Utilization of prescription drug monitoring programs for prescribing and dispensing decisions: Results from a multi-site qualitative study.

Prescription drug monitoring programs (PDMPs) track the dispensing of prescription-controlled substances with the goal of mitigating misuse and diversion. Authorized users query the PDMP for controlled substance prescription histories at the point of care. Despite widespread implementation of PDMPs, there is much not known about how PDMPs influence prescribing and dispensing decisions. The objective of this study was to investigate how primary care providers (PCPs) and pharmacists utilize PDMPs when making prescribing and dispensing decisions. Data from in-depth, qualitative interviews with PCPs (n = 48) and community pharmacists (n = 60) across four states- Arkansas, Idaho, Kentucky, and Washington were analyzed for themes around PDMP use. Both PCPs and pharmacists reported that PDMPs are key tools for aiding prescribing and dispensing decisions. PCPs reported variable use of PDMPs with most querying the PDMP when there are "red flags" and fewer reporting having clinic policies that direct PDMP use. Primary care providers in Kentucky reported more consistent and routine use of the PDMP as a result of a state law that mandates query prior to the initial prescribing of Schedule II controlled substances. Community pharmacists practicing in chain pharmacies reported formal policies requiring PDMP query prior to dispensing opioids, while utilization of PDMPs by pharmacists practicing in independently-owned pharmacies was more variable. Pharmacists and PCPs reported barriers to PDMP use, such as having to "log in on a separate machine" and perceived that PDMP utility could be improved by integrating it within pharmacy dispensing systems and electronic health records. Pharmacists and PCPs reported the importance of PDMP information to aid their prescribing and dispensing decisions. Efforts to enhance state PDMP programs should consider processes that seamlessly integrate all available controlled substance prescription history for a given patient at the point of care so that PDMP utility for prescribing and dispensing decisions is maximized.

PHP213 - Trends in the Texas Prescription Drug Monitoring Program: Registration and Utilization Among Physicians and Pharmacists

Prescription drug monitoring programs (PDMPs) have been purported to be an effective tool in mitigating misuse and diversion. The Texas PDMP launched in August 2012 under law enforcement administration. Approximately 24 states have instituted a mandate for providers to register and/or use their state PDMP. Therefore, the study objective was to examine trends in registration and use of the Texas PDMP by physicians and pharmacists after PDMP administration was transferred to the Texas State Board of Pharmacy (TSBP) on September 1, 2016. PDMP registration and utilization data by profession type (e.g., pharmacists) were obtained from the TSBP. Descriptive statistics were used to delineate monthly trends by profession and the totals one year before and year after the TSBP became the PDMP administrator. PDMP registrations by user role were analyzed from September 2016 to August 2017. The number of physicians and pharmacists that were registered during the first month of the TSBP administering the PDMP (September 2016) was 2,012 and 2,097. From October 2016 to August 2017, the number of registrants remained fairly consistent by physicians and pharmacists with 551 and 365 average registrations per month. Between September 2016 and August 2017, PDMP utilization (i.e., searching patient data) was 1,786,416 queries by 8,077 physicians and 1,089,015 queries by 6,114 pharmacists. Overall, the number of patient history queries increased over the period from September 2016 to August 2017 for both physicians and pharmacists. Physician and pharmacist delegates for PDMP access showed percentage increases of 2911.1% and 7933.3%, respectively during the first month under the TSBP. The use of the PDMP among registrants (physicians and pharmacists) has improved since the TSBP became the administering agency. New initiatives, such as incorporating the PDMP into electronic health records data and pharmacy software may be effective toward increasing PDMP utilization.

Prescription drug monitoring program utilization among 15 US opioid treatment programs

Prescription drug monitoring program utilization among 15 US opioid treatment programs

Trends in Florida's Prescription Drug Monitoring Program registration and utilization: Implications for increasing voluntary use.

Effective use of state prescription drug monitoring programs (PDMPs) to track controlled substance prescribing and dispensing may help mitigate the current opioid crisis. Our objective was to examine trends in registration for and use of Florida's PDMP by physicians and pharmacists, from 2013 to 2016. We discuss implications for PDMP uptake and policy. Key measures, such as cumulative number of registrants per license type and monthly utilization intensity, are presented. A time series forecasting approach was used to (1) model the monthly count of new PDMP registrants and users from January 2013 to December 2016 and (2) estimate cumulative registration totals after 1 year. Florida. As of November 2016, there were 16,498 physicians (representing 31 percent of Drug Enforcement Administration licensees) and 17,241 pharmacists registered with the PDMP, representing 21 and 57 percent of professional licensees, respectively. Of note, the PDMP's designation as a "specialized registry" for electronic medical record "meaningful use" criteria led to a nearly sevenfold increase in physician registrations in a single month. In November 2016, pharmacists displayed a higher past-month PDMP utilization rate (52.2 percent vs 30.1 percent), while physicians displayed a higher past-month PDMP utilization intensity (58.1 vs. 36.1 queries per user). Approximately 25,000 physicians and 31,000 pharmacists must register by the end of 2017 to meet national policy goals. PDMP registration among physicians and pharmacists is limited, and the use of the PDMP among registrants is more limited still. Our findings suggest that Florida will not meet national policy goals for registrants by the end of 2017, although new initiatives may alter this trend. Allowing the PDMP to help prescribers meet other professional needs, such as "meaningful use" or similar efforts, may be effective in increasing PDMP use.

The current utilization and perceptions of prescription drug monitoring programs among emergency medicine providers in Florida

BackgroundPain is among the most commonly treated symptoms in the emergency department, and opioids are commonly prescribed from the emergency department to treat moderate to severe pain. Prescription drug monitoring programs (PDMP) can be used to assist physicians identify individuals at increased risk to misuse or abuse opioids. While the use of the PDMP has been shown useful among clinicians, in the past, utilization of the PDMP has been less than optimal. The objective of this study was to assess the current utilization and perceptions of the prescription drug monitoring program among emergency medicine providers in Florida.MethodsA survey assessing the utilization and perception of Florida’s prescription drug monitoring program was distributed to emergency medicine providers in Florida over a 5 week period. Attending physicians, physicians in training, and extenders from a variety of practice types were assessed.ResultsA total of 88 surveys were completed. Over two thirds (67%) of the respondents were male. The majority of respondents were attending physicians (62%), 13 (14%) were residents, and 21 (23%) were extenders. Nearly all (99%) were aware of Electronic-Florida Online Reporting of Controlled Substance Evaluation Program (EFORCSE) and 84% had registered accounts. More than 2/3 (73%) reported feeling pressured to prescribe opioids, and 70% reported receiving no formal education on identifying individuals at increased risk of opioid misuse. Approximately half (51%) reported that they used EFORCSE only when they suspect the patient may misuse the medication, 21% reported that they rarely used EFORCSE, and only 3% reported using PDMP every time that they prescribed opioids. Residents used PDMP less frequently than extenders and attending physicians. The most common barriers associated with PDMP use were related to access.ConclusionsAlthough most providers reported that they were aware of their states’ PDMP, utilization of the PDMP among emergency medicine providers in Florida remains low. Low utilization was associated with barriers to access. If further enhancements to PDMPs can be made to improve accessibility, then rates of PDMP utilization may increase.

Promoting consistent use of prescription drug monitoring programs (PDMP) in outpatient pharmacies: Removing administrative barriers and increasing awareness of Rx drug abuse.

Prescription drug monitoring programs (PDMPs) are proving to be valuable resources in fighting the prescription drug abuse epidemic through improved access to patient drug histories. Ninety-four percent of Indiana pharmacists have heard of Indiana's PDMP (INSPECT), only 71% of them reported using the program in 2012. To identify barriers to PDMP use in outpatient pharmacies and determine the impact these barriers have on utilization. A cross-sectional study examined pharmacists' knowledge and use of INSPECT. Bivariate analyses on utilization and perceived barriers were conducted using cross-tabulations and chi-squared tests. Multiple logistic regression examined the relationship between pharmacists' level of concern with prescription drug abuse and reported utilization. Pharmacists were significantly less likely to use INSPECT if they reported at least one barrier and 3 times more likely to use INSPECT if they reported no barrier. Pharmacists were 10 times more likely to use INSPECT and 18 times more likely to use it more consistently if they were extremely concerned about prescription drug abuse in their community as compared to those not at all concerned. Strategies to improve utilization of PDMPs should look for innovative ways to limit barriers and build outpatient pharmacists' awareness of prescription drug abuse and misuse within their community.

Prescription drug monitoring program utilization in Kentucky community pharmacies.

Identify characteristics of Kentucky community pharmacists and community pharmacists' practice environment associated with utilization of the Kentucky All Schedule Prescription Electronic Reporting Program (KASPER). Surveys were mailed to all 1,018 Kentucky pharmacists with a KASPER account and an additional 1,000 licensed pharmacists without an account. Bivariate analyses examined the association between KASPER utilization and practice type (independent or chain) and practice location (rural or urban). A multivariate Poisson regression model with robust error variance estimated risk ratios (RR) of KASPER utilization by characteristics of pharmacists' practice environment. Responses were received from 563 pharmacists (response rate 27.9%). Of these, 402 responses from community pharmacists were included in the analyses. A majority of responding pharmacists (84%) indicated they or someone in their pharmacy had requested a patient's controlled substance history since KASPER's inception. Bivariate results showed that pharmacists who practiced in independent pharmacies reported greater KASPER utilization (94%) than pharmacists in chain pharmacies (75%; p<0.001). Multivariate regression results found utilization of KASPER varied significantly among practice environments of community pharmacists with those who practiced in an urban location (RR: 1.11; [1.01-1.21]) or at an independent pharmacy (RR: 1.27; [1.14-1.40]) having an increased likelihood of KASPER utilization. Utilization of KASPER differs by community pharmacists' practice environment, predominantly by practice type and location. Understanding characteristics of community pharmacists and community pharmacists' practice environment associated with PDMP use is necessary to remove barriers to access and increase utilization thereby increasing PDMP effectiveness.

The effects of North Carolina's prescription drug monitoring program on the prescribing behaviors of the state's providers.

State-level prescription drug monitoring programs (PDMPs) show promise as a key strategy to respond to the epidemic of the misuse and abuse of controlled substances (CS), particularly opioid analgesics, in the United States. Undocumented concerns have been expressed that these PDMPs may have a "chilling effect" on providers' willingness to prescribe these substances to their patients. Using data from North Carolina's PDMP for the 3-year period from 2009 through 2011, we examined whether rapid increases in (1) the number of providers who queried the system, and (2) the number of days on which they queried it, would be related to their prescribing practices in regards to CS. We hypothesized that neither marker of PDMP utilization would be associated with a decrease in either patients receiving CS prescriptions or CS prescriptions filled. We found no association between either of these variables and the number of patients who filled prescriptions for CS or the number of prescriptions for CS filled. However, we did find a slight positive relationship between the growth in the utilization of the PDMP and the number of prescriptions filled for opioid analgesics. Concerns that PDMPs may constrain prescribing behavior with regards to CS are not supported.