How Clinicians Use Prescription Drug Monitoring Programs: A Qualitative Inquiry

Abstract

Objectives Prescription drug monitoring programs (PDMP) are now active in most states to assist clinicians in identifying potential controlled drug misuse, diversion or excessive prescribing. Little is still known about the ways in which they are incorporated into workflow and clinical decision making, what barriers continue to exist, and how clinicians are sharing PDMP results with their patients. Design Qualitative data were collected through online focus groups and telephone interviews Setting Clinicians from pain management, emergency and family medicine, psychiatry/behavioral health, rehabilitation medicine, internal medicine and dentistry. Subjects 35 clinicians from 9 states participated. Methods We conducted two online focus groups and seven telephone interviews. A multidisciplinary team then used a grounded theory approach coupled with an immersion-crystallization strategy for identifying key themes in the resulting transcripts. Results Some participants, mainly from pain clinics, reported checking the PDMP with every patient, every time. Others checked only for new patients, for new opioid prescriptions, or for patients for whom they suspected abuse. Participants described varied approaches to sharing PDMP information with patients, including openly discussing potential addiction or safety concerns; avoiding discussion altogether; and approaching discussion confrontationally. Participants described patient anger or denial as a common response and noted the role of patient satisfaction surveys as an influence on prescribing. Conclusion Routines for accessing PDMP data and how clinicians respond to it vary widely. As PDMP use becomes more widespread, it will be important to understand what approaches are most effective for identifying and addressing unsafe medication use.

Clinical Styles and Practice Policies: Influence on Communication with Patients Regarding Worrisome Prescription Drug Monitoring Program Data: Table 1

“…In our previous focus groups with providers in nine states, 6 participants reported discussing worrisome PDMP profiles with patients in a variety of ways, we found similar results in our interviews with Oregon clinicians. Focus groups and surveys of clinician PDMP users identified experiences of both positive and negative patient responses to discussion of worrisome PDMP profiles, with some reporting patient anger or denial.…”

“…Prior focus group research with clinicians suggested that PDMP use might vary depending on whether the patient was a new or existing patient. 6 We designed the interview guide to explore this distinction and how it might affect clinical decisions, actions, and patient interactions. The interview guide is available in the appendix.…”

Leading a Horse to Water

“…How this change affected prescribing clinicians is not yet clear, but other studies have described important communication between pharmacists and clinicians regarding PDMP findings. 11 Some states have mandated use of the PDMP in certain circumstances or by certain prescribers (eg emergency physicians), and some have mandated registration by all prescribers. 1 Though the impact of these mandates is not yet well-studied, our findings suggest they are likely to increase PDMP use.…”

Disclosure of Use and Abuse of Controlled Substances Among Psychiatric Outpatients

“…3 However, the ways in which PDMPs are used in clinical settings vary widely depending on the type of practice, specialty, patient population, and other factors such as patient satisfaction surveys. 23,24 A national survey of physicians who primarily practice emergency medicine that asked about their knowledge and use of PDMPs revealed that, although awareness was high (87.2%), only 50.6% had ever used their state's PDMP, of whom only 30% reported being regular users. Time and complexity required to access relevant information were barriers to PDMP use.…”