Prescriptive Thinking – the Prescription Advisory Blog

Our thoughts on the evolving prescription monitoring landscape.

Prescription Advisory Blog
Opioids and malpractice risks

Opioids and malpractice risks

Medscape's Robert Lowes recently published an article detailing opioids' prominent role in medication malpractice claims. Much of the press around the opioid crisis covers the deaths, hospitalizations, and substance use disorder problems. All of these can lead to...

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Opioid recipients often use multiple prescribers

Opioid recipients often use multiple prescribers

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...

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NJ and PMP – Prescriptive Thinking

NJ and PMP – Prescriptive Thinking

Governor Chris Christie signed a bill on July 20th, 2015 requiring drug prescribers and pharmacists in NJ to register for the state’s Prescription Monitoring Program (PMP) and to check the PMP when prescribing controlled substances. “We’re not only...

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Pain Patients are not all Degenerates

Pain Patients are not all Degenerates

Two important articles have come out just in the past few days. Journal of the American Medical Association The first is a JAMA published article about opioid overdose. If I allow myself to do a substantial study the disservice of ultra-condensing its learnings, it...

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Complicated Value Creation

Complicated Value Creation

Today I want to talk more about business, than about prescription drug abuse. In selling PastRx, we run into an issue. Prescribers understand how our system will protect their patients, and lead to better outcomes. They understand how it will protect them from the DEA...

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The Origins of Prescription Advisory

The Origins of Prescription Advisory

Just over two years ago, I met with my old friend Dr. Frederic “Skip” Leeds. We were just catching up on what was happening in our lives, and with our families. Skip mentioned that he was working on something pretty interesting.  In response to a growing problem with...

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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.

PDMP [National] Center of Excellence at Brandeis U, 2014

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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