BMJ recently published an analysis of opioid prescribing among Medicare patients –“Opioid prescribering by multiple providers in Medicare: retrospective observational study of insurance claims”.

A couple of things jumped out:

  • Just over two thirds of opioid recipients had more than one opioid prescription.
  • Usually the opioid recipients had prescriptions from two or more doctors, if they had multiple prescriptions.

For patients taking opioids, this means an over 40% chance that your patient has at least one other opioid prescription from another practice.

 

Checking the PDMP is the only reliable way to get this information.

 

Of course, at Prescription Advisory, we do this for every patient, every time, automatically, and bring prescriptions from outside your practice to your immediate attention.

 

How do you find your 40% with outside prescriptions? How do you manage the conversation? I’d love hear your solution.

 

David Stengle, Chief Marketing Officer

 

PDMPs have many limitations in their current format, including complex access issues, timeliness, and whether the data are presented to the physician automatically or require physician effort to retrieve.

ACEP - Annals of Emergency Medicine – 525

Prescription drug monitoring programs (PDMPs) 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 participated.

Patients
Thirty-five clinicians from nine 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.

Pain Medicine, Volume 15, Issue 7, July 2014 

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Emergency Physicians must balance under-treatment of pain with concerns about drug diversion and doctor shopping. Use of a state PDMP may help identify patients who are at high risk for prescription opioid diversion or doctor shopping… To quantify the effects of PDMPs, studies were conducted of ED providers who cared for adult patients with pain. Of the patients with complete data in one study, information from the state’s PDMP System altered prescribing practice in 41%. Knowledge of the i…

ACEP - Annals of Emergency Medicine – 525

Doctors (and other clinicians) need to know what prescriptions have been given to their patients by other practitioners. This information should be included in the patients’ electronic health care records accessible through a Prescription Drug Monitoring Program (PDMP) that provides immediate information.

Presentation by the Dir., Div. of Epidemiology  NIH, National Institute on Drug Abuse, May 2013
David Stengle

David Stengle

Chief Marketing Officer at Prescription Advisory
David is Prescription Advisory's Chief Marketing Officer. Software startups are his passion.

He also serves as the Director of Startup Grind Princeton and a mentor for the Princeton University eLab.
David Stengle
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