A Statewide Prescription Monitoring Program Affects Emergency Department Prescribing Behaviors

Baehren, David F.; Marco, Catherine A.; Droz, Danna; Sinha, S.; Callan, Elizabeth; Akpunonu, Peter

doi:10.1016/j.annemergmed.2009.12.011

Cited by 186 publications

(140 citation statements)

References 19 publications

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“…Additionally, published federal and state guidelines for OA prescribing and/or institutional guidelines or mandates, as well as PDMPs, are widespread and affect prescribing practices [8,9]. However, the implementation of institutional policies varies widely.…”

mentioning

confidence: 99%

Opioid Prescribing: How Well Do We Know Ourselves?

Wightman

Nelson

2016

J. Med. Toxicol.

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Get your facts first, then you can distort them as you please.-Mark Twain BI would rather over-prescribe and risk some medication diversion or non-medical use, than under-prescribe and not treat a patient's pain.^This statement, taken from a survey published in the current issue of JMT by Pomerleau et al. 2016 [1], was used to assess clinicians' self-reported attitude about the challenge in meeting individual patient needs while balancing public health risk. The statement essentially pinpoints the current dilemma in the ED: alleviation of suffering in an individual may expose that patient or others (through misuse or diversion) to the risk of opioid analgesic (OA) abuse, addiction, overdose, and death. Pain-related complaints are the most common reason for Emergency Department (ED) visits [2,3], and ED providers are among the top five medical specialist groups writing prescriptions for OAs in patients under 40 years of age [4]. However, only 17 % of ED patients are given a prescription for an OA on discharge and the majority of prescriptions dispensed are for a small number of immediate release pills [5,6]. Still, iatrogenic opioid abuse and addiction remain a concern, because half of ED patients with opioid-use disorders were first exposed to an opioid by a prescription from a medical provider [7].Responsible opioid analgesic prescribing is paramount in our efforts to combat the epidemic of opioid abuse and promote safe opioid use, but little is currently known about which factors drive decision-making among emergency department (ED) prescribers of OAs. Pomerleau et al. highlights the complexity of the decision-making process and brings forth a number of interesting issues. Through a series of queries, the study explores the factors providers believe affect their OA prescribing practices, as well as their attitudes toward OA prescribing. Of course, individual provider opinions and attitudes cannot provide the complete picture. Patient age, race, type of insurance, provider training and experience, functionality of PDMPs, and geographic location are a few of the many factors highlighted in the literature to affect OA prescribing decisions.Whether to prescribe an OA for any given patient not only depends on the aforementioned patient and provider factors and the culture of the work environment, but also on the quality and type of patient doctor communication. One study showed that when faced with identical hypothetical case scenarios, ED physicians' decisions whether to prescribe an OA varied greatly [14]. For the same clinical scenario, subtle differences in the patient-doctor interaction (for example, a patient requesting a specific drug or an additional dose of pain medication) could change the likelihood of prescribing substantially [18]. To support this unconscious bias, Pomerleau, et al. uncovered some interesting paradoxes. For example, survey respondents report that they would be less likely to write a prescription for a patient with an opioid use disorder, but they also state their skills to identify pat...

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mentioning

confidence: 99%

Opioid Prescribing: How Well Do We Know Ourselves?

Wightman

Nelson

2016

J. Med. Toxicol.

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“…Other states allow closely regulated access by prescribers, pharmacists, medical examiners, and law enforcement personnel. A prescriber's ability to access PDMP data at the time of prescribing may significantly affect a PDMP's impact on prescribing practices [17,18]. Access Requirements.…”

Section: Individual Pdmp Characteristics By Statementioning

confidence: 99%

“…Study authors also reported that, in some cases, PDMP data resulted in increased rather than decreased prescribing, indicating the possibility that a PDMP could facilitate more individualized pain medication prescribing. This single-institution study was somewhat limited by the fact that one study author treated approximately one third of the patients studied [17]. In 2008, a study of buprenorphine use in France for long-term opioid maintenance found that implementation of a PDMP correlated with a precipitous drop in doctor-shopping, as measured by a variable combining early refills and multiple prescribing practitioners per patient.…”

Section: Effectiveness Of Pdmpsmentioning

confidence: 99%

Windmills and Pill Mills: Can PDMPs Tilt the Prescription Drug Epidemic?

2012

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Prescription drug monitoring programs (PDMPs) are state-based registries of prescriptions for specific controlled substances. This overview will describe the history and funding of these databases, address those characteristics thought to be of greatest utility for PDMPs and review current literature regarding PDMP effectiveness and their potential limitations. Although more extensive research on PDMP outcomes is needed, these databases are an essential component in ongoing efforts to establish safe and compassionate prescription opioid stewardship.

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“…Although uptake of PDMP use has been slow among providers, researchers have found an association between PDMP use and reduced fraudulent prescription-seeking behavior and unnecessary health care utilization resulting from nonmedical use of opioid analgesics. [17][18][19][20][21] ■■ The Lock-In Approach Although PDMPs capture all legally dispensed controlled substance prescriptions in a state, policymakers have also recognized the potential for influencing nonmedical prescription drug use through payer systems, particularly Medicaid programs. Currently, the vast majority of states operate Medicaid "lock-in" programs (MLIPs).…”

Section: ■■ Combating Nonmedical Prescription Use Through Policymentioning

confidence: 99%