Physicians’ Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-State Qualitative Study

Radomski, Thomas R.; Bixler, Felicia R.; Zickmund, Susan; Roman, KatieLynn; Thorpe, Carolyn T.; Hale, Jennifer; Sileanu, Florentina E.; Hausmann, Leslie R.M.; Thorpe, Joshua M.; Suda, Katie J.; Stroupe, Kevin T.; Gordon, Adam J.; Good, Chester B.; Fine, Michael J.; Gellad, Walid F.

doi:10.1007/s11606-018-4374-1

Cited by 29 publications

(42 citation statements)

References 17 publications

(24 reference statements)

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“…Although 30% of the patients seen in outpatient medicine had acute pain, the PDMP was accessed in that setting only 16% of the time. Overall, our results are consistent with other studies that describe low PDMP utilization rates despite reports by providers recognizing that the PDMP is an important clinical tool 12‐15 …”

Section: Discussionsupporting

confidence: 92%

Prescription Drug Monitoring Program: Access in the First Year

et al. 2021

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Background and Objectives Prescription Drug Monitoring Programs (PDMP) detect high‐risk prescribing and patient behaviors. This study describes the characteristics associated with documented PDMP access when prescribing opioids. Methods Retrospective chart review of 695 opioid prescriptions written from inpatient and outpatient medical and psychiatric settings. Data were abstracted and analyzed to identify characteristics associated with documented PDMP access. Results One‐third of the charts had PDMP access documented within the week of opioid prescription; 12% showed PDMP consultation on the same day. Services varied greatly from 10.5% (inpatient medicine) to 57% (inpatient psychiatry) with regard to same‐day PDMP access (P < .0001). Patient characteristics associated with PDMP access include having acute pain, current mental health treatment, and current and past substance use disorders (all P < .05). Logistic regression modeling identified three variables associated with the odds of PDMP access (c‐statistic = 0.66): if the prescription originated from the inpatient medicine unit (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.32, 0.68), or if the patient received a prescription for an opioid in the past 30 days (OR = 0.30, 95% CI = 0.10, 0.90) or had a urine toxicology screen in the past year (OR = 2.00, 95% CI = 1.40, 2.90). Discussion and Conclusions Utilization of the PDMP varied by specialty and setting. Scientific Significance This study is among the first to compare rates of PDMP access in a large sample by specialty and practice setting in a healthcare system with a policy requiring its access and appropriate documentation. With less than one‐third adherence to the policy, additional steps to increase consistent PDMP access are warranted. (Am J Addict 2021;00:00–00)

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Section: Discussionsupporting

confidence: 92%

Prescription Drug Monitoring Program: Access in the First Year

et al. 2021

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“…VA physicians noted that incomplete or unavailable data was a significant barrier to increasing PDMP use. 409 In 2016, HHS issued a policy requiring IHS prescribers to query the PDMP before prescribing opioids and pharmacists to report their dispensing activity to the PDMP; it also directed IHS to ensure that memorandums of understanding were signed with the appropriate state offices. 49,410 Links to and use of PDMPs varies across IHS service areas.…”

Section: Prescription Drug Monitoring Programsmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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“… 27 Enforcement may also be limited by implementation barriers such as limited resources. 27 Qualitative research has identified some key factors influencing implementation of PDMPs such as linkage to electronic health records (EHR), 29 - 31 and communication barriers between physicians and pharmacists. 32 , 33 In addition, qualitative research has illuminated the perceived unintended consequences of the PDMP by PDMP staff, law enforcement officials, and administrative agency employees.…”

Section: Introductionmentioning

confidence: 99%

Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin

et al. 2021

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Background and aims: Prescription Drug Monitoring Programs (PDMPs) were designed to curb opioid misuse and diversion by tracking scheduled medications prescribed by medical providers and dispensed by pharmacies. The effects of PDMPs on opioid prescription, misuse and overdose rates have been mixed due in part to variability in states’ PDMPs and difficulties measuring this complexity, and a lack of attention to implementation and enforcement of PDMP components. The current study uses qualitative interviews with key informants from 3 states with different PDMPs, Connecticut, Kentucky and Wisconsin to explore differences in the characteristics of the PDMPs in each state; how they are implemented, monitored and enforced; and unintended negative consequences of these programs. Methods: We conducted in-depth interviews with key informants from each state representing the following sectors: PDMP and pain clinic regulation agencies, Medicaid programs, state licensing boards, pharmacies, emergency medicine departments, pain management clinics, first responders, drug courts, drug treatment programs, medication assisted treatment (MAT) providers, and harm reduction organizations. Interview guides explored participants’ experiences with and opinions of PDMPs according to their roles. Data analysis was conducted using a collaborative, constant comparison method. Results: While all 3 states had mandated registration and reporting requirements, the states differed in the implementation and enforcement of these and the extent to which provider prescribing was monitored. These, in turn, influenced how medical providers perceived the PDMP and changed how providers prescribed opioids. Unintended consequences of state PDMPs included under-prescribing for pain and “dumping” patients who were long term users of opioids or who had developed opioid use disorders and may explain the increase in illicit heroin or opioid use. Conclusion: State PDMPs with similar mandates may differ greatly in implementation and enforcement. These differences are important to consider when determining the effects of PDMPs on opioid misuse and overdose.

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Physicians’ Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-State Qualitative Study

Abstract: Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids.

Cited by 29 publications

References 17 publications

Prescription Drug Monitoring Program: Access in the First Year

Prescription Drug Monitoring Program: Access in the First Year

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin

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