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.
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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Although relieving pain and reducing suffering are primary emergency physician responsibilities, there is a concurrent duty to limit the personal and societal harm that can result from prescription drug misuse and abuse.
Recommendations for full use of PDMP include:
- PDMPs can be effective clinical tools in medication management involving controlled substances.
- PDMPs should be available for clinicians across state boundaries.
- Every prescribing clinician should be familiar with the process of accessing and utilizing information from PDMP’s so that they can incorporate this information in their practices.
Thirteen multi-state PDMP projects were sponsored in 2012-13. While providers indicated that PDMPs gave them more confidence for prescribing pain medication, the study concluded that the easier the data is to obtain, the more they will be used, and the safer the practice can be.
Use of a state PDMP may help identify patients who are at high risk for 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%.
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.
The use of PDMPs…is helping to reduce misuse of prescription drugs.
Whenever possible, orthopaedic surgeons should request and review old medical records and speak with the patient’s primary physician about past medication problems. Currently, states have Prescription Drug Monitoring Programs designed to assist law enforcement in the identification of doctor shoppers; these data are also accessible to physicians.
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.
An improved PDMP … with accurate and timely data analysis should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.
A study was conducted to estimate the societal costs of prescription opioid abuse, dependence, and misuse in the United States. Costs were grouped into three categories: health care, workplace, and criminal justice.
The results: Total US societal costs of prescription opioid abuse were estimated at $55.7 billion in 2007 (USD in 2009). Workplace costs accounted for $25.6 billion, health care costs accounted for $25.0 billion, and criminal justice costs accounted for $5.1 billion. Workplace costs were driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).
Conclusions: The costs of prescription opioid abuse represent a substantial and growing economic burden for the society. The increasing prevalence of abuse suggests an even greater societal burden in the future.
Attention to patterns of prescription requests and the prescribing of opioids as part of an ongoing relationship between a patient and a healthcare provider can decrease the risk of diversion. Periodic review of state PDMP, where available, is also a useful tool to monitor compliance. Evaluation should initially include…a drug history… Documentation is essential.
An improved PDMP … with accurate and timely data analysis should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.
Whenever possible, orthopaedic surgeons should request and review old medical records and speak with the patient’s primary physician about past medication problems. Currently, states have Prescription Drug Monitoring Programs designed to assist law enforcement in the identification of doctor shoppers; these data are also accessible to physicians.
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.
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.
What prescribers can do to safely and effectively use opioids for CNCP (includes the following)
- Screen for prior or current substance abuse/misuse
- Do not use concomitant sedative–hypnotics or benzodiazepines
- Track daily MED using an online dosing calculator
- Use the state Prescription Drug Monitoring Program to monitor all sources of controlled substances
In 2012, both New York and Tennessee required prescribers to check their state’s PDMP before prescribing painkillers.
The results one year later:
New York realized a 75% drop and Tennessee a 36% drop in patients who were seeing multiple prescribers to obtain the same drugs.
The CDC advises providers to use PDMPs… States should consider ways to increase their use … available real-time, and alerts to prescribers.
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.
You’re not only reducing the supply [of pain medications] for those who use them inappropriately, but also for those in need.