Clinicians’ Use of Prescription Drug Monitoring Programs in Clinical Practice and Decision-Making: Table 1

Leichtling, Gillian; Irvine, Jessica M.; Hildebran, Christi; Cohen, Deborah J.; Hallvik, Sara E.; Deyo, Richard A.

doi:10.1093/pm/pnw251

Cited by 26 publications

(46 citation statements)

References 32 publications

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“…the Washington Department of Health (DOH) PDMP operations manager. 18,[22][23][24][25][26][27] The survey instrument was pretested with 8 pharmacists with different backgrounds and experience to ensure validity and clarity on questions, response choice, and length. On the basis of pilot feedback, the survey underwent minor modifications.…”

Section: Resultsmentioning

confidence: 99%

Prescription drug monitoring program use and utility by Washington State pharmacists: A mixed-methods study

Pett¹,

Mancl²,

Revere³

et al. 2020

Journal of the American Pharmacists Association

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Objectives: To explore factors and situations that influence pharmacists to use the prescription drug monitoring program (PDMP) and to characterize actions taken by pharmacists after alarming scenarios from a PDMP query. Design: Explanatory sequential 2-phase mixed-methods design: (1) cross-sectional Webbased survey of Washington State pharmacists followed by (2) interviews with purposefully selected respondents to explore statistically significant quantitative findings. Setting and participants: The study was conducted in Washington State from September 2018 to February 2019. A total of 967 Washington State pharmacists from various practice settings, including inpatient and outpatient pharmacies, participated. Ten outpatient pharmacists were interviewed in the second phase. Outcome measures: The pharmacists reported the frequency of PDMP use, opinion on the usefulness of PDMP, and action(s) taken after a concerning PDMP report. Results: The usable response rate for pharmacists with a PDMP account was 17.6% (818/4659), and usable response rate for all pharmacists was 10.4% (967/9263). PDMP use varied by race, practice setting, and employer policy on PDMP use. Among the 818 PDMP users, 396 (48%) used the database at least once during a shift. Frequent PDMP users were more likely to recommend naloxone compared with less frequent users (adjusted odds ratio 1.70 [95% CI 1.09e2.65], P ¼ 0.02). The following 3 interview themes were identified: time, company policy, and red flags. Conclusion: PDMP has value to pharmacists of all practice settings studied. Frequent PDMP use may facilitate more pharmacist interventions, such as a naloxone prescription. Published by Elsevier Inc. on behalf of the American Pharmacists Association.

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Section: Resultsmentioning

confidence: 99%

Prescription drug monitoring program use and utility by Washington State pharmacists: A mixed-methods study

Pett¹,

Mancl²,

Revere³

et al. 2020

Journal of the American Pharmacists Association

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“…In a survey of Texas community pharmacists, it was found that patients paying for controlled substances with cash or obtaining early refills were the most influential triggers for PMP use (Fleming et al, 2014). Several studies related similar findings where providers reported accessing the PMP when they were suspicious of the patient's drugseeking behavior (Hildebran et al, 2014; Irvine et al, 2014; Leichtling et al, 2017). Our study found that health care providers rated patients' misuse as the most important reason to consult with the PMP.…”

Section: Influence Of Vignette Variablesmentioning

confidence: 91%

Factors Influencing Judgments to Consult Prescription Monitoring Programs: A Factorial Survey Experiment

Witry

Marie

Viyyuri

et al. 2020

Pain Management Nursing

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Background: Prescription monitoring programs (PMPs) can provide health care professionals with valuable information. However, few studies have explored providers' decision making for accessing PMPs. Aims: This study aimed to identify provider characteristics and situational factors most influencing perceived importance of consulting the PMP for patients in a simulated context. Design: The study used a cross-sectional factorial survey. Settings: The survey was administered electronically. Participants/Subjects: Community pharmacists, advanced practice registered nurses (APRNs), and physicians in Iowa. Methods: Participants were recruited by mail which included a link to the online survey. The survey consisted of demographic questions, eight randomly generated vignettes, and one ranked item. The vignettes described a hypothetical prescription using eight experimental variables whose levels were randomly varied. Respondents evaluated each vignette for importance to access the PMP. Analyses used linear mixed-effects models in R (Version 3.5.0). Results: A total of 138 responses were available for multilevel analysis. Women, physicians, and APRNs rated it more important to consult the PMP for a given prescription compared with men and pharmacists. Accessing a PMP was perceived as more important with cash payments, quantity dispensed, suspicion for misuse, hydromorphone and oxycodone prescriptions, and headache. Advancing age, postoperative pain, and anxiety or sleep indications were associated with less importance. Conclusions: Age, indication for prescribing, misuse, and payment mode each independently had greater importance to providers in accessing the PMP. This was the first study to isolate the influence of different controlled substances on how important it was to consult the PMP.

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“…Prescribers are left to grapple with the long-standing issue of BDZ dependence on a case-by-case basis, and this environment has unmasked tensions between patient stigma and the prescribers' duty of care [83]. More specifically, when required to manage a potentially inappropriate prescription, prescribers' decision-making is often guided by the patient-prescriber relationship [84], meaning they may decide to cease a prescription if they doubt a patients' intention, or if they had a prior negative experience with the patient. This is not surprising given the lack of guidance on managing competing needs of a patient dependent or "misusing" BDZs, and a prescriber held to account for dispensing a medication flagged as inappropriate by a PMP.…”

Section: The Prescriber's Dilemmamentioning

confidence: 99%

Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use

Oldenhof

Anderson-Wurf²,

Hall

et al. 2019

JCM

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Internationally there is an escalation of prescription-related overdose deaths, particularly related to benzodiazepine use. As a result, many countries have implemented prescription monitoring programs (PMPs) to increase the regulation of benzodiazepine medications. PMPs centralize prescription data for prescribers and pharmacists and generate alerts to high-doses, risky combinations, or multiple prescribers with the aim to reduce inappropriate prescribing and subsequently the potential of patient harm. However, it has become clear that prescribers have been provided with minimal guidance and insufficient training to effectively integrate PMP information into their decision making around prescribing these medications. Accordingly, this paper discusses how PMPs have given rise to a range of unintended consequences in those who have been prescribed benzodiazepines (BDZs). Given that a gradual taper is generally required to mitigate withdrawal from BDZs, there are concerns that alerts from PMPs have resulted in BDZs being ceased abruptly, resulting in a range of unintended harms to patients. It is argued that best practice guidelines based upon a patient-centered framework of decision-making, need to be developed and implemented, in order to curtail the unintended consequences of PMPs. This paper outlines some key considerations when starting the conversation with patients about their BDZ use.

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Clinicians’ Use of Prescription Drug Monitoring Programs in Clinical Practice and Decision-Making: Table 1

Cited by 26 publications

References 32 publications

Prescription drug monitoring program use and utility by Washington State pharmacists: A mixed-methods study

Prescription drug monitoring program use and utility by Washington State pharmacists: A mixed-methods study

Factors Influencing Judgments to Consult Prescription Monitoring Programs: A Factorial Survey Experiment

Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use

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