ORLANDO, Fla. — Prescription drug monitoring programs could be more useful to physicians if their results were available in a more readable format, researchers said here.
The opioid epidemic continues to rage in the U.S., noted Scott Weiner, MD, MPH, attending physician at Brigham and Women’s Hospital in Boston. “For the second year in a row, life expectancy in the U.S. has dropped … We haven’t seen that since the AIDS epidemic, and it’s mainly contributed to by overdose deaths.”
To help find patients with a potential addiction problem, prescription drug monitoring programs (PDMPs) are now in use in 50 states, and prescriber use is mandated in many of those, Weiner said here at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).
But even though checking the PDMP is required, not all prescribers do so, said Jaya Tripathi, principal analyst for analytics at the MITRE Corporation in Bedford, Mass. A study conducted by her company in 2013 and revised in 2017 found that although 77% of responding physicians used an electronic health record, 22% said they didn’t log into a PDMP when prescribing opioids or other drugs that mandate its use.
A 2014 study of 420 physicians by Johns Hopkins University found similar results, Tripathi said: 53% of respondents said they had used their state’s PDMP program, while 22% said they weren’t sure whether or not their state had such a program.
One reason respondents to the MITRE survey said they didn’t use the PDMP is because “it’s difficult to glean a lot of information from the standard patient presentation on the PDMP,” she noted.
Finding a Better Way
How could PDMPs be improved? Weiner and colleagues set out to study the issue. They first convened an online focus group in 2017 with 21 PDMP administrators in 18 states to find out what they would like to see in a PDMP. The investigators found support for, including summary information, patients’ controlled substance prescription history; respondents also said a morphine milligram equivalent calculator would be helpful. However, they also said having too much summary data could be a disadvantage in that it could discourage providers from doing an in-depth examination of the patient’s profile, said Weiner.
“The key theme I was most surprised at was that administrators actually want us clinicians to think for ourselves,” said Weiner. “I thought that was kind of ironic because as a prescriber, what I was looking for was a way to interpret this data really quickly. I wanted it to be processed and spat out to me in a way that was really easily digestible, that would save time for me and make things more objective. But the administrators actually had more faith in the clinicians. They actually thought looking at these more nuanced profiles, looking at the different prescriptions and taking it all into context would be better than just giving a summary format for providers.”
In the second part of their study, the researchers sought to find out what prescribers wanted from the PDMP. They surveyed 93 physicians who attended one of three conferences: a family physician conference, an emergency physician conference, and a regional anesthesia and pain medicine physician conference. Survey participants had to have practiced at least 500 hours in the past 12 months and had to have reviewed at least 10 PDMP profiles during that period.
Participants were shown three simulated patient vignettes: a 35-year-old with low back pain, a 20-year-old with a rib fracture, and a 60-year-old with shingles. “We tried to pick profiles that were ambiguous … where the provider may or may not decide to write an opioid prescription,” Weiner said. The patients also had complex PDMP profiles; for example, one patient had only seven prescriptions and three prescribers, and they used a single pharmacy — but the patient was also getting oxycodone/acetaminophen (Percocet) and diazepam (Valium) from two different providers, “and when you mix those two together, your risk of overdose goes up markedly.”
The researchers created a simulated PDMP profile for each patient that included:
- An overdose risk score for each patient — “We didn’t tell them what it meant; we just gave them a risk score,” Weiner said
- A prescription summary showing how many prescribers the patient had, as well as the number of prescriptions written in the past 12 months
- A list of risk factors for overdose, with items highlighted in red if they applied to that particular patient
- A graph showing the patient’s daily morphine milligram equivalent (MME) dosage
“Prescribers liked the enhanced PDMP profile,” said Weiner. “More than anything, the thing they were most interested in was saving time, and they thought this would reduce their time burden.”
They also thought it could be good for provider-patient communication, he added, with doctors suggesting they could print it out and say to their patient, “Let’s talk about this.” “On the other hand, there [also] were some concerns,” Weiner said. “They were worried that if there was a high risk score and they prescribed to a patient, what if that opened them up to liability? And they also thought they needed transparency in how risk scores were calculated and how [we defined] MME.”
When respondents were asked to rate the usefulness of the PDMP enhancements on a scale of 1 (most useful) to 5 (least useful), Weiner was surprised to find that the risk score was rated least useful, while the prescription summary and risk factors were rated higher. “I thought the risk score would have been at the top, but it actually wasn’t,” he said.
A Role for the States
State governments are also trying to make PDMPs easier to use. In Rhode Island, officials have had some success in using the state’s health information exchange to integrate patients’ electronic health record data with the state’s PDMP, Melissa Lauer, a health information technology specialist with the Rhode Island Office of Health and Human Services, explained during a different panel discussion at the meeting.
“The really cool thing with our first integration is we found one of the major benefits of this was it reduced the time to check the PDMP,” Lauer said. “The team observed providers checking the PDMP before and after, and it took them 3 to 5 minutes to check the PDMP before [the integration] and only 5 seconds after, which is a major deal when you’re talking about 15-minute visits … It also helped ensure providers would stay in compliance with the state law that requires providers check the PDMP before the first time they prescribe an opioid.”