Evidence based practices to optimize prescriber use

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1 Overview,3 Background,7 Evaluating Evidence Based PDMP Practices. Methodology 7,Limitations 7,8 DMP Practices That Support Increased Prescriber. Utilization,Prescriber use mandates 8,Case studies on prescriber use mandates 12. Kentucky enacts the first comprehensive prescriber use mandate 12. New York works with stakeholders to build support for prescriber mandate 15. Ohio adjusts prescriber use mandate with updated law 17. Delegation 18,Case studies on delegation 20, Kentucky becomes an early adopter of delegation 20. Oregon surveys highlight the need for delegation 21. Maine takes cues from other states key stakeholders in documenting the need for delegation 22. Unsolicited reports 23,Case studies on unsolicited reports 26.
Maine enhances unsolicited reporting with electronic alerts prescriber set thresholds 26. Indiana implements user led unsolicited reporting 27. Massachusetts transitions to electronic unsolicited reporting analyzes alerts 28. Data timeliness 29,Case studies on data timeliness 32. Oklahoma pioneers real time PDMP updates 32, Kentucky requires daily PDMP updates after considering real time 33. Streamlined enrollment 34,Case studies on streamlined enrollment 37. Tennessee uses online registration to facilitate implementation of use mandate 37. Minnesota s online enrollment results in time savings 38. Massachusetts targets 100 percent enrollment with automatic registration 38. Educational and promotional initiatives 39, Case studies on educational and promotional initiatives 41. Maine uses surveys other research to target educational initiatives 41. Florida uses prescriber outreach to increase enrollment and use 43. New York launches educational initiative for prescriber use mandate 44. Health information technology integration 45,Case studies on health IT integration 48.
Indiana advances health IT integration with a two phase pilot 48. Washington integrates PDMP data with the state health information exchange 49. Enhanced user interfaces 51,Case studies on enhanced user interfaces 52. New Jersey develops first PDMP mobile device application 52. Indiana explores PDMP analytics through a federally funded pilot project 53. California develops high risk alert dashboard 55,56 Synergistic and Emerging Practices. 59 Conclusion, 60 ppendix A Prescriber Enrollment and Use of PDMPs. by Program,62 Appendix B PDMP Planning Tool,73 Appendix C Methodology. 75 ppendix D States Mandating That Prescribers Make. Comprehensive Use of PDMP Data Prior to Issuing,Controlled Substance Prescriptions.
82 ppendix E Status of Adoption of Evidence Based Practices. to Optimize Prescriber Use of PDMPs X References,85 Endnotes. The Pew Charitable Trusts,Susan K Urahn executive vice president. Allan Coukell senior director health programs,Josh Rising director health care programs. Cynthia Reilly director substance use prevention and treatment initiative. Pew Project Team,Alaina McBournie senior associate. Sheri Lawal senior associate, Institute for Behavioral Health Heller School for Social Policy.
and Management at Brandeis University,Grant Carrow Ph D project consultant. Thomas W Clark research associate, John L Eadie M P A public health PDMP project coordinator National Emerging Threats Initiative. former director PDMP Center of Excellence at Brandeis University. Peter W Kreiner Ph D senior scientist,Ruslan V Nikitin M Sc research associate. Acknowledgments, The authors would like to thank state prescription drug monitoring program staff for their invaluable responses. to the survey other assistance in clarifying program operations and in case study states review of the sections. in which their PDMPs were featured This report benefited from the insights and expertise of external reviewers. G Caleb Alexander M D Christopher Baumgartner Harry Chen M D Heather Gray David Hopkins Michelle. Ricco Jonas Yngvild Olsen M D and Chad Zadrazil J D Any opinions and conclusions expressed herein are. those of The Pew Charitable Trusts and the Institute for Behavioral Health and do not necessarily represent the. views of the above individuals The Pew project team also would like to acknowledge the following staff members. for their contributions Erin Davis and Demetra Aposporos for their editorial input Mel Grant for preparing this. work for publication Samantha Chao Alan van der Hilst Airlie Loiaconi and Timothy Cordova for providing. research guidance and ensuring the accuracy of this report and a special thanks to Elizabeth Jungman who. played an instrumental role in the planning and development of this work. This work was originally conducted by the Prescription Drug Monitoring Program Center for Excellence at Brandeis University In. September 2016 the Center merged with the PDMP Training and Technical Assistance Center a project that operates under the Institute. for Behavioral Health Heller School for Social Policy and Management at Brandeis University. Contact Erin Davis communications Email edavis pewtrusts org Phone 202 540 6677. The Pew Charitable Trusts is driven by the power of knowledge to solve today s most challenging problems Pew applies a rigorous analytical. approach to improve public policy inform the public and invigorate civic life. The prescription opioid epidemic poses major threats to the nation s health According to the Centers for. Disease Control and Prevention approximately 19 000 people in the United States died from overdoses involving. prescription opioids in 2014 a 16 percent increase from the previous year and the highest number ever. recorded 1 Emergency room visits by people using opioids for nonmedical reasons such as taking a higher than. prescribed dose or a prescription intended for another person increased 117 percent between 2005 and 2011 2. Furthermore people who are addicted to prescription opioids are 40 times more likely to become addicted to. heroin 3 And the rate of deaths involving heroin increased nearly fivefold between 1999 and 2014 4 with more. than 10 500 people dying of heroin related overdoses in 2014. Because increased prescribing of opioids has been a primary driver of the prescription opioid epidemic reducing. the overprescribing of these therapies is a primary focus of efforts to reverse these trends 5. Prescription drug monitoring programs PDMPs are state based electronic databases that contain information. on controlled substance prescriptions dispensed by pharmacies and prescribers These programs can help reduce. the misuse and diversion the redirection of drugs from legal medically authorized uses to illegal uses of. controlled substances including prescription opioids. PDMPs allow prescribers and pharmacists as well as other individuals and entities such as researchers. health insurers and medical licensing boards that are authorized to access the data to monitor controlled. substance use by patients the prescribing practices of medical practitioners and population level drug use. trends For example a prescriber who is considering issuing a controlled substance prescription can check a. patient s exposure to commonly misused drugs such as opioid pain relievers and benzodiazepine anti anxiety. medications licensing boards can use the data to identify aberrant prescribing patterns by practitioners and. state public health officials can use aggregated PDMP data to inform the development and implementation of. targeted public health interventions such as prescriber education campaigns However the type of access that. is authorized varies by user For instance while prescribers have access to PDMPs and use them to examine. controlled substance prescriptions on the individual patient level state public health officials can access PDMP. data only at the aggregate level Additional information on these and other PDMP uses is available in the. Background section of this report, According to the Prescription Drug Monitoring Program Training and Technical Assistance Center a.
partnership of the Bureau of Justice Assistance and the Heller School for Social Policy and Management at. Brandeis University that helps stakeholders plan implement standardize and enhance PDMPs the number of. PDMPs has grown rapidly in the past 15 years with programs now operational in all states with the exception. of Missouri Guam and the District of Columbia 6 However the number of prescribers utilizing PDMPs remains. low thus limiting the effectiveness of these databases. The White House Office of National Drug Control Policy which has said that PDMPs are critical to improving. public health 7 has set a goal of doubling the number of health practitioners registered with PDMPs by 2017 8. Consequently PDMP administrators state and federal health officials professional organizations and legislators. are examining ways to increase prescriber use of PDMPs. This report written by researchers from the Institute for Behavioral Health Heller School for Social Policy and. Management at Brandeis University in collaboration with The Pew Charitable Trusts describes eight evidence. based practices aimed at increasing prescriber utilization of PDMPs. Prescriber use mandates, Requiring a prescriber to view a patient s PDMP data under certain circumstances. such as before writing an initial prescription for a controlled substance. Delegation, Allowing prescribers to designate someone on staff such as a nurse to access the. PDMP on their behalf to help manage workflow,Unsolicited reports. Proactively sending communications from PDMP staff to prescribers dispensers. law enforcement and regulators to flag potentially harmful drug use or prescribing. activity based on PDMP data,Data timeliness, Uploading information into the database at set intervals whether in real time daily. weekly or monthly Dispensers which include pharmacies and prescribers who. provide medications directly to patients are responsible for uploading data. Streamlined enrollment, Simplifying processes such as instituting automatic PDMP registration triggered by.
state controlled substance registration to more easily enable prescribers to enroll in. Educational and promotional initiatives, Making efforts to promote the program including prescriber training via formats. that include online videos and instructional materials on how to access and use. Health information technology IT integration, Combining PDMP data with other clinical data through technologies that are used. to store communicate and analyze health information such as electronic health. Enhanced user interfaces, Implementing user friendly technologies such as dashboards and mobile applications. that provide PDMP data in easily understandable formats. The extent and quality of evidence of these practices effectiveness varies but there is sufficient information to. conclude that adopting one or more of them will increase prescriber utilization of PDMPs The review of available. evidence found that the practices can work in the following ways. Prescriber use mandates can rapidly increase PDMP utilization which can have an immediate impact on. prescriber behavior helping to reduce inappropriate prescribing of opioids and benzodiazepines and also. multiple provider episodes when patients visit numerous prescribers and or pharmacies to obtain the same. or similar drugs in a short time span Kentucky New York and Ohio are potential models for states looking to. mandate PDMP use, Delegate accounts daily dispenser reporting a common approach to improving data timeliness and. streamlined enrollment are practical solutions already adopted by nearly half of states and are feasible to. implement based on state experience Kentucky Maine and Oregon can offer lessons to states interested in. delegate accounts while Kentucky and Oklahoma can serve as examples for states interested in improving. data timeliness Experiences in Massachusetts Minnesota and Tennessee can also inform states hoping to. streamline enrollment, Unsolicited reporting and educational and promotional initiatives are effective mechanisms to encourage.
enrolled prescribers to use the database and also to inform unenrolled prescribers about the value of PDMPs. especially in states that lack a prescriber use mandate States looking to send unsolicited reports can learn. from experiences in Indiana Maine and Massachusetts similarly states looking to bolster educational and. promotional initiatives can take cues from Florida Maine and New York. Health IT integration and enhanced user interfaces can be effective in helping address barriers to using. PDMPs as demonstrated by pilot studies and state based projects but strategies for implementing these. practices on a wide scale require further study Indiana and Washington are potential models for states that. wish to pursue health IT integration states aiming to enhance user interfaces can look to California Indiana. and New Jersey for guidance, This report also includes case studies of states that have implemented one or more of these practices. Background, PDMPs are essential tools for addressing the prescription opioid epidemic 9 These programs provide secure. online access to a database of dispensed controlled substance prescriptions for a variety of authorized users and. they serve as a key resource for individuals and agencies responsible for addressing this public health problem. While most states engage in one or more evidence based PDMP practic. Evidence based practices to optimize prescriber use Contents 1 Overview 3 Background 7 Evaluating Evidence Based PDMP Practices Methodology 7 Limitations 7 8 PDMP Practices That Support Increased Prescriber Utilization Prescriber use mandates 8 Case studies on prescriber use mandates 12 Kentucky enacts the first comprehensive prescriber use mandate 12 New York works with stakeholders to build

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