Managing Compliance

Prescription drug overdose is the number one cause of accidental death in the United States. Beyond these tragic deaths, prescription drug abuse causes many more emergency room visits and billions of dollars in medical expenses. Every incident represents a problem and a potential liability.

Identifying risks early helps manage risks associated with overdose and abuse. Armed with better information in a useful form, physicians can help identify abusers and direct them to treatment earlier in the process.

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PastRx does more.

We automatically check every patient. This means you have confidence that every needed check required by your state happens, and that your practice is going above and beyond to assess patient risks.

Our analytics help you see patterns within your patient population as well as anticipating your state or payer’s unsolicited reports. For organizations that self-insure, this insight gives you additional protection through earlier identification of problems.

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The AAOS recommends the following tools, which have been shown to significantly reduce medication errors:

  • computerized physician order entry
  • computerized decision support systems
  • computerized monitoring of adverse drug events
  • pharmacist-assisted rounds
  • high-risk drug protocols

Overdose deaths are “just the tip of the iceberg”: that for every death there are many more hospital treatment admissions, emergency room visits, people who abuse or are dependent on prescription drugs and nonmedical users.

American Psychological Association

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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