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Corry B, Cremer LJ, Donnelly C, Sargent WM, Mells J, Kelly R, Reynolds J, Young LD. Changes in opioid prescribing and prescription drug monitoring program utilization following electronic health record integration-Massachusetts, 2018. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:380-386. [PMID: 38407391 PMCID: PMC11147687 DOI: 10.1093/pm/pnae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE In this study, we explored key prescription drug monitoring program-related outcomes among clinicians from a broad cohort of Massachusetts healthcare facilities following prescription drug monitoring program (PDMP) and electronic health record (EHR) data integration. METHODS Outcomes included seven-day rolling averages of opioids prescribed, morphine milligram equivalents (MMEs) prescribed, and PDMP queries. We employed a longitudinal study design to analyze PDMP data over a 15-month study period which allowed for six and a half months of pre- and post-integration observations surrounding a two-month integration period. We used longitudinal mixed effects models to examine the effect of EHR integration on each of the key outcomes. RESULTS Following EHR integration, PDMP queries increased both through the web-based portal and in total (0.037, [95% CI = 0.017, 0.057] and 0.056, [95% CI = 0.035, 0.077]). Both measures of clinician opioid prescribing declined throughout the study period; however, no significant effect following EHR integration was observed. These results were consistent when our analysis was applied to a subset consisting only of continuous PDMP users. CONCLUSIONS Our results support EHR integration contributing to PDMP utilization by clinicians but do not support changes in opioid prescribing behavior.
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Affiliation(s)
- Brian Corry
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Laura J Cremer
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Christopher Donnelly
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Wesley M Sargent
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Jamie Mells
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Rodd Kelly
- Massachusetts Department of Public Health, Massachusetts Prescription Monitoring Program, Bureau of Health Professions Licensure, Boston, MA 02108, USA
| | - Joshua Reynolds
- Massachusetts Department of Public Health, Massachusetts Prescription Monitoring Program, Bureau of Health Professions Licensure, Boston, MA 02108, USA
| | - Leonard D Young
- Massachusetts Department of Public Health, Massachusetts Prescription Monitoring Program, Bureau of Health Professions Licensure, Boston, MA 02108, USA
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Hoppe JA, Ledbetter C, Tolle H, Heard K. Implementation of Electronic Health Record Integration and Clinical Decision Support to Improve Emergency Department Prescription Drug Monitoring Program Use. Ann Emerg Med 2024; 83:3-13. [PMID: 37632496 DOI: 10.1016/j.annemergmed.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 08/28/2023]
Abstract
STUDY OBJECTIVE(S) To evaluate the implementation of 3 electronic health record (EHR)-based interventions to increase prescription drug monitoring program (PDMP) use in the emergency department (ED): EHR-PDMP integration, addition of a PDMP risk score, and addition of EHR-based clinical decision support alert to review the PDMP when prescribing an opioid. METHODS Three intervention stages were implemented using a prospective stepped-wedge design at 5 university-affiliated EDs split into 3 practice groups. The PDMP use and prescribing rates during the 3 stages were compared with baseline before EHR integration and a sustainability stage where the clinical decision support alert was removed, but EHR integration and risk score remained. Generalized linear mixed model with logit link function and a random intercept for clinicians was analyzed. RESULTS The ED provider PDMP review before opioid prescribing was low in all stages. The highest review rate occurred during interruptive clinical decision support alerts, 23.8% (interquartile range 10.6 to 37.5). Overall, opioid prescribing declined, and PDMP review was not associated with a decrease in opioid prescribing. PDMP review was associated with a reduction in the probability of prescribing an opioid as the number of prior opioid prescriptions increased (odds ratio: 0.92 [95% confidence interval: 0.91 to 0.94] for every additional prescription). CONCLUSION The EHR-PDMP integration did not increase PDMP use in the ED, but a PDMP risk score and a clinical decision support alert were associated with modest increases in the probability of PDMP review. When the PDMP is reviewed, ED clinicians are less likely to prescribe opioids to patients with a high number of prior opioid prescriptions.
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Affiliation(s)
- Jason A Hoppe
- Department of Emergency Medicine, University of Colorado, Aurora, CO.
| | - Caroline Ledbetter
- Center for Innovative Design and Analysis, the Colorado School of Public Health, Aurora, CO
| | - Heather Tolle
- Department of Emergency Medicine, University of Colorado, Aurora, CO
| | - Kennon Heard
- Department of Emergency Medicine, University of Colorado, Aurora, CO
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Adalbert JR, Syal A, Varshney K, George B, Hom J, Ilyas AM. The prescription drug monitoring program in a multifactorial approach to the opioid crisis: PDMP data, Pennsylvania, 2016-2020. BMC Health Serv Res 2023; 23:364. [PMID: 37046254 PMCID: PMC10100464 DOI: 10.1186/s12913-023-09272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Prescription opioids remain an important contributor to the United States opioid crisis and to the development of opioid use disorder for opioid-naïve individuals. Recent legislative actions, such as the implementation of state prescription drug monitoring programs (PDMPs), aim to reduce opioid morbidity and mortality through enhanced tracking and reporting of prescription data. The primary objective of our study was to describe the opioid prescribing trends in the state of Pennsylvania (PA) as recorded by the PA PDMP following legislative changes in reporting guidelines, and discuss the PDMP's role in a multifactorial approach to opioid harm reduction. METHODS State-level opioid prescription data summaries recorded by the PA PDMP for each calendar quarter from August 2016 through March 2020 were collected from the PA Department of Health. Data for oxycodone, hydrocodone, and morphine were analyzed by quarter for total prescription numbers and refills. Prescription lengths, pill quantities, and average morphine milliequivalents (MMEs) were analyzed by quarter for all 14 opioid prescription variants recorded by the PA PDMP. Linear regression was conducted for each group of variables to identify significant differences in prescribing trends. RESULTS For total prescriptions dispensed, the number of oxycodone, hydrocodone, and morphine prescriptions decreased by 34.4, 44.6, and 22.3% respectively (p < 0.0001). Refills fluctuated less consistently with general peaks in Q3 of 2017 and Q3 of 2018 (p = 0.2878). The rate of prescribing for all opioid prescription lengths decreased, ranging in frequency from 22 to 30 days (47.5% of prescriptions) to 31+ days of opioids (0.8% of prescriptions) (p < 0.0001). Similarly, decreased prescribing was observed for all prescription amounts, ranging in frequency from 22 to 60 pills (36.6% of prescriptions) to 60-90 pills (14.2% of prescriptions) (p < 0.0001). Overall, the average MME per opioid prescription decreased by 18.9%. CONCLUSIONS Per the PA PDMP database, opioid prescribing has decreased significantly in PA from 2016 to 2020. The PDMP database is an important tool for tracking opioid prescribing trends in PA, and PDMPs structured similarly in other states may enhance our ability to understand and influence the trajectory of the U.S. opioid crisis. Further research is needed to determine optimal PDMP policies and practices nationwide.
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Affiliation(s)
- Jenna R Adalbert
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Jefferson College of Population Health, Philadelphia, PA, USA.
| | - Amit Syal
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Karan Varshney
- Jefferson College of Population Health, Philadelphia, PA, USA
- Deakin University School of Medicine, Geelong, VIC, USA
| | - Brandon George
- Jefferson College of Population Health, Philadelphia, PA, USA
| | - Jeffrey Hom
- Jefferson College of Population Health, Philadelphia, PA, USA
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Asif M Ilyas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopaedic Institute Foundation for Opioid Research & Education, Philadelphia, PA, USA
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Richwine C, Everson J. National Estimates and Physician-Reported Impacts of Prescription Drug Monitoring Program Use. J Gen Intern Med 2023; 38:881-888. [PMID: 36229762 PMCID: PMC10039204 DOI: 10.1007/s11606-022-07793-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite widespread adoption of state prescription drug monitoring programs (PDMPs), it is unclear how often PDMPs are accessed through an electronic health record system (EHR-PDMP integration), or whether efforts to make PDMPs easier to access and use have improved their utility. OBJECTIVE To produce national-level estimates on the use of PDMPs among office-based physicians and benefits associated with their use. DESIGN We use nationally representative survey data to produce descriptive statistics on PDMP use and associated benefits among office-based physicians in the USA. PARTICIPANTS 1398 office-based physicians who prescribe controlled substances. MAIN MEASURES We examined physician-reported ease and frequency of PDMP use, and how EHR-PDMP integration affects frequency and ease of use. Multivariate models were used to assess whether characteristics of PDMP use were related to physician-reported benefits such as reduced prescribing of controlled substances and perceived improvements in clinical decision-making. KEY RESULTS In 2019, two-thirds of office-based physicians in the USA reported frequent use of their state PDMP and over three-quarters reported they were easy to use. Both frequency and ease of use were positively correlated with PDMP integration status. Respondents who frequently checked their state's PDMP were 8.7 percentage points (95% CI -.4 to 17.8) more likely to report perceived benefits and reported 2.2 (95% CI 1.54 to 2.83) more benefits. Respondents who indicated their PDMP was easy to use were 12.7 percentage points (95% CI .040 to .214) more likely to report perceived benefits and reported 0.94 (95% CI 0.26 to 1.61) more benefits. CONCLUSIONS Our findings suggest efforts to make PDMPs easier to access and use aided physicians in making informed clinical decisions that may not be captured by reduced prescribing alone. Efforts to further increase frequency and ease of use-including advancing a standards-based approach to PDMP and EHR data interoperability-may further increase the benefit of PDMPs.
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Affiliation(s)
- Chelsea Richwine
- Office of Technology, Office of the National Coordinator for Health Information Technology, Washington, DC, USA.
| | - Jordan Everson
- Office of Technology, Office of the National Coordinator for Health Information Technology, Washington, DC, USA
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Barriers to Increasing Prescription Drug Monitoring Program Use: A Multidisciplinary Perspective. COMPUTERS, INFORMATICS, NURSING : CIN 2023:00024665-990000000-00083. [PMID: 36728156 PMCID: PMC10349893 DOI: 10.1097/cin.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prescription drug monitoring programs are implemented through individual state policies and are one solution to curb the opioid crisis. The objectives of this study are to: (1) describe the multidisciplinary experiences using this program in practice; (2) identify limitations of the program and the desired features for improvement; and (3) characterize expectations for improved access when prescription drug monitoring programs are embedded in the electronic health record. A qualitative descriptive study design used semistructured interviews of 15 multidisciplinary healthcare providers. Textual data were analyzed using content analysis. Results showed the prescription drug monitoring program was helpful to decision-making processes related to opioid prescribing and referral to treatment; there were barriers limiting healthcare providers' use of the prescription drug monitoring program; preferences were delineated for integrating prescription drug monitoring program into electronic health record; and recommendations were provided to improve the program and increase use. In conclusion, the prescription drug monitoring program was viewed as useful in making strides to reduce the impact of inappropriate opioid prescribing in our country. By engaging a multidisciplinary group of healthcare providers, solutions were offered to improve the interface and function of the prescription drug monitoring program to assist in increasing use.
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Hoppe D, Karimi L, Khalil H. Mapping the research addressing prescription drug monitoring programs: A scoping review. Drug Alcohol Rev 2022; 41:803-817. [PMID: 35106867 DOI: 10.1111/dar.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
ISSUES Prescription drug monitoring programs are a harm minimisation intervention and clinical decision support tool that address the public health concern surrounding prescription drug misuse. Given the large number of studies published to date and the ongoing implementation of these programs, it is important to map the literature and identify areas for further research to improve practice. APPROACH A scoping review was undertaken to identify the research on prescription drug monitoring programs published between January 2015 and April 2021. KEY FINDINGS A total of 153 citations were included in this scoping review. The majority of the studies originated from the USA and were quantitative. Results on program effectiveness are mixed and mainly examine their association with opioid-related outcomes. Unintended consequences are revealed in the literature and this review also highlights barriers to program use. IMPLICATIONS Overall, findings are mixed despite the large number of studies published to date. Mapping the literature identifies priority areas for further research that can advise policymakers and clinicians on practice improvement. CONCLUSION Results on prescription drug monitoring program effectiveness are mixed and mainly examine their association with opioid-related outcomes. This review highlights barriers to prescription drug monitoring program effectiveness related to program use and system integration. Further research is needed in these areas to improve prescription drug monitoring program use and patient outcomes.
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Affiliation(s)
- Dimi Hoppe
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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The Impact of a PDMP-EHR Data Integration Combined With Clinical Decision Support on Opioid and Benzodiazepine Prescribing Across Clinicians in a Metropolitan Area. J Addict Med 2022; 16:324-332. [PMID: 34392255 PMCID: PMC8831644 DOI: 10.1097/adm.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Despite inconclusive evidence that prescription drug monitoring programs (PDMP) reduce opioid-related mortality, guidelines recommend PDMP review with opioid prescribing. Some reported barriers to use include time-consuming processes to obtain data and workflow disruptions. METHODS We provided access to a PMDP-electronic health record (EHR) integrated program to 123 clinicians in one healthcare system. Remaining clinicians within the healthcare system and metropolitan area did not receive PDMP-EHR integration program access. We identified changes in opioid prescribing by linking prescription data available in the state PMDP database to individual clinicians. The primary outcome was change in receipt of high dose opioid prescriptions (>90 mg morphine equivalents) by Colorado residents before and after program integration. Secondary outcomes included changes in long-acting opioid receipt and overlapping opioid and benzodiazepine prescription days. Next, we surveyed clinicians to assess their perspectives on PDMP data acquisition before and after PDMP-EHR integration program access. RESULTS High-dose opioid receipt decreased significantly across all 3 clinician groups [PDMP-EHR integration program access (27.6%, to 6.9%, P < 0.001); no program access in the same healthcare system (4.8% to 2.9%, P < 0.001), and no program access across the metropolitan area (13.5% to 6.1%, P < 0.001)]. Clinicians reported improved access to PDMP data using the PDMP-EHR integrated program compared to the state PDMP website (98.6%). CONCLUSIONS Further study of PDMP-EHR integration programs on patient and clinician outcomes may illuminate the role of this technology in public health and in clinical practice.
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Weiner SG, Kobayashi K, Reynolds J, Chan K, Kelly R, Wakeman S, Reddy P, Young LD. Opioid Prescribing After Implementation of Single Click Access to a State Prescription Drug Monitoring Program Database in a Health System's Electronic Health Record. PAIN MEDICINE 2021; 22:2218-2223. [PMID: 33561288 DOI: 10.1093/pm/pnab051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the effect of one-click integration of a state's prescription drug monitoring program (PDMP) on the number of PDMP searches and opioid prescriptions, stratified by specialty. METHODS Our large health system worked with the state department of public health to integrate the PDMP with the electronic health record (EHR), which enabled providers to query the data with a single click inside the EHR environment. We evaluated Schedule II or III opioid prescriptions reported to the Massachusetts PDMP 6 months before (November 15, 2017-May 15, 2018) and 6 months after (May 16, 2018, to November 16, 2018) integration. Search counts, prescriptions, patients, morphine milligram equivalents, as well as prescriber specialty were compared. RESULTS There were 3,185 unique prescribers with a record of a Schedule II and/or III opioid prescription in both study periods that met inclusion criteria. After integration, the number of PDMP searches increased from 208,684 in the pre-integration phase to 298,478 searches in the post-integration phase (+43.0%). The number of opioid prescriptions dispensed decreased by 4.8%, the number of patients receiving a prescription decreased by 5.1%, and the mean morphine milligram equivalents (MMEs) per prescriber decreased by 5.4%. There were some notable specialty-specific differences in these measures. CONCLUSIONS Integration of the PDMP into the EHR markedly increased the number of searches but was associated with modest decreases in opioids prescribed and patients receiving a prescription. Single click EHR integration of the PDMP, if implemented broadly, may be a way for states to significantly increase PDMP utilization.
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Affiliation(s)
| | | | - Joshua Reynolds
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Kit Chan
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Rodd Kelly
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Sarah Wakeman
- Massachusetts General Hospital Boston, Massachusetts
| | | | - Leonard D Young
- Massachusetts Department of Public Health, Boston, Massachusetts
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Robinson A, Wilson MN, Hayden JA, Rhodes E, Campbell S, MacDougall P, Asbridge M. Health Care Provider Utilization of Prescription Monitoring Programs: A Systematic Review and Meta-Analysis. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:1570-1582. [PMID: 33484144 PMCID: PMC8311582 DOI: 10.1093/pm/pnaa412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To synthesize the literature on the proportion of health care providers who access and use prescription monitoring program data in their practice, as well as associated barriers to the use of such data. DESIGN We performed a systematic review using a standard systematic review method with meta-analysis and qualitative meta-summary. We included full-published peer-reviewed reports of study data, as well as theses and dissertations. METHODS We identified relevant quantitative and qualitative studies. We synthesized outcomes related to prescription monitoring program data use (i.e., ever used, frequency of use). We pooled the proportion of health care providers who had ever used prescription monitoring program data by using random effects models, and we used meta-summary methodology to identify prescription monitoring program use barriers. RESULTS Fifty-three studies were included in our review, all from the United States. Of these, 46 reported on prescription monitoring program use and 32 reported on barriers. The pooled proportion of health care providers who had ever used prescription monitoring program data was 0.57 (95% confidence interval: 0.48-0.66). Common barriers to prescription monitoring program data use included time constraints and administrative burdens, low perceived value of prescription monitoring program data, and problems with prescription monitoring program system usability. CONCLUSIONS Our study found that health care providers underutilize prescription monitoring program data and that many barriers exist to prescription monitoring program data use.
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Affiliation(s)
- Alysia Robinson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maria N Wilson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Rhodes
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samuel Campbell
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter MacDougall
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Anesthesiology, Pain Management and Peri-Operative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Crawford M, Farahmand P, McShane EK, Schein AZ, Richmond J, Chang G. Prescription Drug Monitoring Program: Access in the First Year. Am J Addict 2021; 30:376-381. [PMID: 33760317 DOI: 10.1111/ajad.13154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prescription Drug Monitoring Programs (PDMP) detect high-risk prescribing and patient behaviors. This study describes the characteristics associated with documented PDMP access when prescribing opioids. METHODS Retrospective chart review of 695 opioid prescriptions written from inpatient and outpatient medical and psychiatric settings. Data were abstracted and analyzed to identify characteristics associated with documented PDMP access. RESULTS One-third of the charts had PDMP access documented within the week of opioid prescription; 12% showed PDMP consultation on the same day. Services varied greatly from 10.5% (inpatient medicine) to 57% (inpatient psychiatry) with regard to same-day PDMP access (P < .0001). Patient characteristics associated with PDMP access include having acute pain, current mental health treatment, and current and past substance use disorders (all P < .05). Logistic regression modeling identified three variables associated with the odds of PDMP access (c-statistic = 0.66): if the prescription originated from the inpatient medicine unit (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.32, 0.68), or if the patient received a prescription for an opioid in the past 30 days (OR = 0.30, 95% CI = 0.10, 0.90) or had a urine toxicology screen in the past year (OR = 2.00, 95% CI = 1.40, 2.90). DISCUSSION AND CONCLUSIONS Utilization of the PDMP varied by specialty and setting. SCIENTIFIC SIGNIFICANCE This study is among the first to compare rates of PDMP access in a large sample by specialty and practice setting in a healthcare system with a policy requiring its access and appropriate documentation. With less than one-third adherence to the policy, additional steps to increase consistent PDMP access are warranted. (Am J Addict 2021;00:00-00).
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Affiliation(s)
- Mitchell Crawford
- Harvard Medical School, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts
| | | | | | - Abigail Z Schein
- Harvard Medical School, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts
| | - Janet Richmond
- VA Boston Healthcare System, Boston, Massachusetts.,Tufts University, School of Medicine, Boston, Massachusetts
| | - Grace Chang
- Harvard Medical School, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts
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Martin HD, Modi SS, Feldman SS. Barriers and facilitators to PDMP IS Success in the US: A systematic review. Drug Alcohol Depend 2021; 219:108460. [PMID: 33387937 DOI: 10.1016/j.drugalcdep.2020.108460] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Prescription Drug Monitoring Programs (PDMP) help prevent prescription drug misuse and promote appropriate pain management. Despite these benefits and PDMP mandates in most states, PDMPs face challenges that hinder their success. This paper uses the Delone and McLean Information Success (IS) Model to review the current literature for barriers and facilitators to PDMP quality, use, intention to use and user satisfaction in the United States (U.S.). MATERIAL AND METHODS Scopus, PubMed and Embase databases were searched due to their relevance to information technology, education and research. RESULTS There were 142 and 183 barriers and facilitators, respectively, found in 44 peer reviewed articles. Barriers to PDMP quality, use and user satisfaction include lack of interstate data sharing, access difficulties, lack of time, inability to delegate access, lack of knowledge or awareness of the PMDP, and lack of EHR integration. Facilitators to PDMP quality, use and user satisfaction include interstate data connections, real-time data updates, EHR integration, and access delegation. DISCUSSION Interstate data sharing, EHR integration and expanding access to delegates were common themes found. Some results were found to be contradictory such as mandating use. CONCLUSION PDMP users can use these findings to assess current barriers to PDMP success in the U.S. and draw possible solutions from the list of facilitators. Practitioners should consider the context of their state and organization when determining which facilitators would most promote PDMP IS success. Combining facilitators may be the best route to PDMP IS success in certain situations.
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Affiliation(s)
- Heather D Martin
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States.
| | - Shikha S Modi
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States
| | - Sue S Feldman
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States
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Whiteside LK, Vrablik MC, Russo J, Bulger EM, Nehra D, Moloney K, Zatzick DF. Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors. Trauma Surg Acute Care Open 2021; 6:e000550. [PMID: 33553651 PMCID: PMC7845668 DOI: 10.1136/tsaco-2020-000550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/07/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
Background Accurate acute care medical utilization history is an important outcome for clinicians and investigators concerned with improving trauma center care. The objective of this study was to examine the accuracy of self-report emergency department (ED) utilization compared with utilization obtained from the Emergency Department Information Exchange (EDIE) in admitted trauma surgery patients with comorbid mental health and substance use problems. Methods This is a retrospective cohort study of 169 injured patients admitted to the University of Washington’s Harborview Level I Trauma Center. Patients had high levels of post-traumatic stress disorder and depressive symptoms, suicidal ideation and alcohol comorbidity. The investigation used EDIE, a novel health technology tool that collects information at the time a patient checks into any ED in Washington and other US states. Patterns of EDIE-documented visits were described, and the accuracy of injured patients’ self-report visits was compared with EDIE-recorded visits during the course of the 12 months prior to the index trauma center admission. Results Overall, 45% of the sample (n=76) inaccurately recalled their ED visits during the past year, with 36 participants (21%) reporting less ED visits than EDIE indicated and 40 (24%) reporting more ED visits than EDIE indicated. Patients with histories of alcohol use problems and major psychiatric illness were more likely to either under-report or over-report ED health service use. Discussion Nearly half of all patients were unable to accurately recall ED visits in the previous 12 months compared with EDIE, with almost one-quarter of patients demonstrating high levels of disagreement. The improved accuracy and ease of use when compared with self-report make EDIE an important tool for both clinical and pragmatic trial longitudinal outcome assessments. Orchestrated investigative and policy efforts could further examine the benefits of introducing EDIE and other information exchanges into routine acute care clinical workflows. Level of evidence II/III. Trial registration number ClinicalTrials.gov NCT02274688.
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Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Marie C Vrablik
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathleen Moloney
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Sundling RA. Attitudes and Knowledge Regarding Pain Management and Addiction in Massachusetts: A Mixed Methods Study on Podiatric Residents. J Am Podiatr Med Assoc 2020; 110:449522. [PMID: 33301577 DOI: 10.7547/18-051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The opioid epidemic has hit disastrous levels across the United States. Many attempts have been made to counteract this, including policy changes and modification of provider and patient behavior. The purpose of this study was to understand the current state of podiatric residents' knowledge regarding pain management and addiction. METHODS This study used mixed quantitative-qualitative methods. Two focus groups were conducted with two podiatric residency programs to understand current issues and inform the creation of a survey. A 30-question survey was created and peer reviewed to assess general pain management knowledge, levels of confidence in pain management and addiction, and areas for improvement. RESULTS Pain management education in podiatry is mainly focused on opioids. These concepts are often taught in a nonstandardized method, which does not often include nonopioid alternatives. Knowledge of risk factors for addiction was lacking, whereas knowledge of behaviors concerning for addiction was more bountiful. Thirty-three surveys were completed of a possible 39. A knowledge score was created from eight survey questions for a total of 10 points, with an average score of 4.61. There was no statistical difference between those with and without a pain management rotation. Nearly all residents felt comfortable managing surgical pain. The residents are "never" or "only occasionally" inquiring about risk factors for addiction. Questions asked also suggest that the residents are not thinking about their role within the opioid epidemic. CONCLUSIONS As the opioid epidemic grows, it is imperative to examine the causes and solutions to the problem. Focusing efforts on educating resident physicians is one method to address the issue. The results of this study show that pain management basics need to be reinforced and more time must be spent emphasizing the importance of thorough patient histories and educating patients when prescribing pain medication.
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Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing. Br J Gen Pract 2020; 70:e589-e597. [PMID: 32540873 DOI: 10.3399/bjgp20x711737] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Understanding barriers to safe opioid prescribing in primary care is critical amid the epidemic of prescription opioid abuse, misuse, and overdose in the US. Educational outreach strategies, such as academic detailing (AD), provide a forum for identification of barriers to, and strategies to facilitate, safe opioid prescribing in primary care. AIM To identify barriers to safe opioid prescribing among primary care providers (PCPs) through AD. DESIGN AND SETTING Qualitative analysis of data was collected through an existing AD intervention to improve safe opioid prescribing in primary care. The AD intervention was delivered from June 2018 to August 2018 to licensed PCPs with prescriptive authority within a large independent health system in the metropolitan Chicagoland area. METHOD The AD intervention involved visits by trained detailers to PCPs who contemporaneously documented details from each visit via field notes. Using qualitative analysis, field notes were analysed to identify recurring themes related to opioid prescribing barriers. RESULTS Detailer-entered field notes from 186 AD visits with PCPs were analysed. Barriers to safe opioid prescribing were organised into six themes: 1) gaps in knowledge; 2) lack of prescription monitoring programme (PMP) utilisation; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices. CONCLUSION Barriers to safe opioid prescribing in primary care, identified through AD visits among this large group of PCPs, support the need for continued efforts to enhance pain-management education, maximise PMP utilisation, and increase access to, and affordability of, non-opioid treatments.
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Madras BK, Ahmad NJ, Wen J, Sharfstein JS. Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System. NAM Perspect 2020; 2020:202004b. [PMID: 35291732 PMCID: PMC8916813 DOI: 10.31478/202004b] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Even though evidence-based treatment for opioid use disorders (OUD) is effective, almost four in five Americans with OUD do not receive any form of treatment. The gap in access to evidence-based care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and financial barriers. Action from a number of actors is urgently needed to address this crisis.
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Affiliation(s)
| | - N Jia Ahmad
- Johns Hopkins Bloomberg School of Public Health
| | - Jenny Wen
- Johns Hopkins University School of Medicine
| | - Joshua Sharfstein Sharfstein
- Johns Hopkins Bloomberg School of Public Health; and the Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic
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American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions. Pain Manag Nurs 2020; 21:7-25. [DOI: 10.1016/j.pmn.2019.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/25/2019] [Accepted: 06/14/2019] [Indexed: 01/12/2023]
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Leichtling G, Hildebran C, Novak K, Alley L, Doyle S, Reilly C, Weiner SG. Physician Responses to Enhanced Prescription Drug Monitoring Program Profiles. PAIN MEDICINE 2020; 21:e9-e21. [PMID: 30698811 DOI: 10.1093/pm/pny291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Many states have begun implementing enhancements to PDMP patient profiles such as summaries or graphics to highlight issues of concern and enhance comprehension. The purpose of this study was to examine how physicians respond to sample enhanced PDMP profiles based on patient vignettes. DESIGN Brief semistructured interviews with physicians. SETTING Three national medical conferences for targeted specialties. SUBJECTS Ninety-three physicians practicing in primary care, emergency medicine, or pain management. METHODS We presented participants with one of three patient vignettes with corresponding standard and enhanced PDMP profiles and conducted brief interviews. RESULTS Findings indicated that enhanced profiles could increase ease of comprehension, reduce time burden, and aid in communicating with patients about opioid risks. Physicians also expressed concern about liability for prescribing when the enhanced profile indicates risk and cautioned against any implication that risk warnings should override clinical judgment based on the patient's complete medical history or presenting condition. Physicians emphasized the need for transparency of measures and evidence of validation of risk scores. We found little indication that enhanced profiles would change opioid prescribing decisions, though decisions varied by physician. CONCLUSIONS Our study underscores the importance of involving prescribers in developing and testing PDMP profile enhancements, as well as providing guidance in the interpretation and clinical use of enhanced profiles. Reduced time burden is an important benefit to consider as the number of states mandating PDMP use increases.
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Affiliation(s)
| | | | | | | | - Sheri Doyle
- The Pew Charitable Trust Substance Use Prevention and Treatment Initiative, Washington DC, USA
| | | | - Scott G Weiner
- Brigham and Women's Hospital, Division of Health Policy Research Translation, Department of Emergency Medicine, Boston, MA.,Harvard Medical School, Department of Emergency Medicine, Boston, MA
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18
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Reist J, Frazier J, Rottingham A, Welsh M, Viyyuri BR, Witry M. Provider beliefs on the Barriers and Facilitators to Prescription Monitoring Programs and Mandated Use. Subst Use Misuse 2020; 55:1-11. [PMID: 31426693 DOI: 10.1080/10826084.2019.1648512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Underutilization of Prescription monitoring programs (PMP), especially in states where participation is voluntary could limit their impact against opioid epidemic. Objectives: To (1) examine PMP use among Iowa healthcare providers (HCPs); (2) identify factors prompting and impeding PMP use, and (3) assess beliefs toward mandating PMP use. Methods: A cross-sectional survey of Iowa HCPs was conducted using a 12-item questionnaire. Survey domains include demographics, current PMP utilization, conditions and barriers associated with PMP use, and perspectives on use mandates. Analyses were based on descriptive statistics, proportional odds and poisson regression models. Results: There were 704 usable responses. Almost all respondents were registered with the PMP with dentists having the lowest rate (p < .001). Nurse practitioners consulted the PMP for the largest proportion of prescriptions, while pharmacists and dentists used significantly less (p < .001). Lack of time was the most common reported barrier impeding PMP use. Red flag behaviors and unfamiliarity with patient were the most common conditions prompting PMP review. HCPs estimated their use of the PMP would significantly increase if integrated into their electronic health records (p < .001). Almost half of HCPs held the opinion that PMP use should never be mandated, although inter-provider variation was present with nurse practitioners most amenable to mandates. Discussion: HCPs displayed variation in PMP use. EMR integration appears to be a strategy for increasing PMP use. There was resistance to mandating PMP use for all controlled substances prescribed and dispensed, with some interest in mandates for new patients only or new controlled substance prescriptions only.
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Affiliation(s)
- Jeff Reist
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Joseph Frazier
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Alecia Rottingham
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Mackenzie Welsh
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Brahmendra Reddy Viyyuri
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Matthew Witry
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
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Mastarone GL, Wyse JJ, Wilbur ER, Morasco BJ, Saha S, Carlson KF. Barriers to Utilization of Prescription Drug Monitoring Programs Among Prescribing Physicians and Advanced Practice Registered Nurses at Veterans Health Administration Facilities in Oregon. PAIN MEDICINE 2019; 21:695-703. [DOI: 10.1093/pm/pnz289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractObjectiveTo identify barriers to using state prescription drug monitoring programs (PDMPs) among prescribing physicians and advanced practice registered nurses across a variety of Veterans Health Administration (VA) settings in Oregon.DesignIn-person and telephone-based qualitative interviews and user experience assessments conducted with 25 VA prescribers in 2018 probed barriers to use of state PDMPs.SettingVA health care facilities in Oregon.SubjectsPhysicians (N = 11) and advanced practice registered nurses (N = 14) who prescribed scheduled medications, provided care to patients receiving opioids, and used PDMPs in their clinical practice. Prescribers were stationed at VA medical centers (N = 10) and community-based outpatient clinics (N = 15); medical specialties included primary care (N = 10), mental health (N = 9), and emergency medicine (N = 6).MethodsUser experience was analyzed using descriptive statistics. Qualitative interviews were analyzed using conventional content analysis methodology.ResultsThe majority of physicians (64%) and advanced practice registered nurses (79%) rated PDMPs as “useful.” However, participants identified both organizational and software design issues as barriers to their efficient use of PDMPs. Organizational barriers included time constraints, clinical team members without access, and lack of clarity regarding the priority of querying PDMPs relative to other pressing clinical tasks. Design barriers included difficulties entering or remembering passwords, unreadable data formats, time-consuming program navigation, and inability to access patient information across state lines.ConclusionsPhysicians and advanced practice registered nurses across diverse VA settings reported that PDMPs are an important tool and contribute to patient safety. However, issues regarding organizational processes and software design impede optimal use of these resources.
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Affiliation(s)
- Ginnifer L Mastarone
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- Department of Communication, College of Liberal Arts & Sciences, Portland State University, Portland, Oregon
| | - Jessica J Wyse
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Eileen R Wilbur
- Pharmacy Services, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- Department of Psychiatry, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, Oregon
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20
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Bachhuber MA, Saloner B, LaRochelle M, Merlin JS, Maughan BC, Polsky D, Shaparin N, Murphy SM. Physician Time Burden Associated with Querying Prescription Drug Monitoring Programs. PAIN MEDICINE 2019; 19:1952-1960. [PMID: 29618105 DOI: 10.1093/pm/pny053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Prescription drug monitoring programs (PDMPs) enable prescribers to review patient prescription histories, and their use is mandatory in many states. We estimated the cost of physicians retrieving PDMP patient reports compared with a model where a delegate (i.e., administrative staff) retrieves reports. Methods We performed a cost analysis with a one-year time horizon, from the perspective of physicians' employers. We obtained specialty-specific estimates of controlled substance prescribing frequency from the National Ambulatory Medical Care Survey, 2012-2014. We defined three PDMP usage cases based on the frequency of queries: comprehensive (before every Schedule II-IV controlled substance prescription), selective (before new Schedule II-IV prescriptions and every six months for continuing medications), and minimal (before new Schedule II or III prescriptions and annually for continuing medications). Results The delegate model was less costly for all specialties in the comprehensive usage case and most specialties in the selective usage case, and it was similar to physician model costs in the minimal usage case. Estimated annual costs of the physician model to a large health care system (1,000 full-time equivalent physicians) were $1.6 million for comprehensive usage, $1.1 million for selective usage, and $645,313 for minimal usage. The delegate model was less costly in the comprehensive (savings of $907,283) and selective usage cases (savings of $156,216). Conclusions Relying on delegates vs physicians to retrieve reports is less costly in most cases. Automation and integration of PDMP data into electronic health records may reduce costs further. Physicians, health care systems, and states should collaborate to streamline access to PDMPs.
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Affiliation(s)
- Marcus A Bachhuber
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Marc LaRochelle
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jessica S Merlin
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brandon C Maughan
- The Lewin Group, Falls Church, Virginia.,Emergency Physicians Integrated Care, Salt Lake City, Utah
| | - Dan Polsky
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naum Shaparin
- Department of Anesthesia, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Sean M Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
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21
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Moyo P, Simoni-Wastila L, Griffin BA, Harrington D, Alexander GC, Palumbo F, Onukwugha E. Prescription drug monitoring programs: Assessing the association between "best practices" and opioid use in Medicare. Health Serv Res 2019; 54:1045-1054. [PMID: 31372990 DOI: 10.1111/1475-6773.13197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To estimate the impact of implementing prescription drug monitoring program (PDMP) best practices on prescription opioid use. DATA SOURCES 2007-2012 Medicare claims for noncancer pain patients, and PDMP attributes from the Prescription Drug Abuse Policy System. STUDY DESIGN We derived PDMP composite scores using the number of best practices adopted by states (range: 0-14), classifying states as either no PDMP, low strength (0 < score < median), or high strength (score ≥ median). Using generalized linear models, we quantified the association between the PDMP score category and opioid use measures-overall and stratified by disability/age. Sensitivity analyses assessed the general Medicare sample regardless of pain diagnoses, individual PDMP characteristics, and compared GEE model findings to models with state fixed effects. PRINCIPAL FINDINGS Compared to non-PDMP states, strong PDMP states had lower opioid cumulative doses (-296 mg; 95% CI: -512, -132), days supplied (-7.84; 95% CI: -10.6, -5.04), prescription fill rates (0.97; 95% CI: 0.95, 0.98), and mean daily doses (-2.31 mg; 95% CI: -3.14, -1.48) but greater prevalence of high opioid doses in disabled adults, whereas there was little or no change in older adults. Findings in states with weak PDMPs were substantively similar to those of strong PDMPs. Results from sensitivity analyses were mostly consistent with main findings except there was a null relationship with mean daily doses and high doses in models with state fixed effects. CONCLUSIONS Comprehensive or minimal adoption of PDMP best practices was associated with mostly comparable effects on Medicare beneficiaries' opioid use; however, these effects were concentrated among nonelderly disabled adults.
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Affiliation(s)
- Patience Moyo
- Brown University School of Public Health, Providence, Rhode Island
| | - Linda Simoni-Wastila
- School of Pharmacy, Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, Maryland
| | | | - Donna Harrington
- University of Maryland School of Social Work, Baltimore, Maryland
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Francis Palumbo
- School of Pharmacy, Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, Maryland
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
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22
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Weiner SG, Sherritt KM, Tseng Z, Tripathi J. Advanced visualizations to interpret prescription drug monitoring program information. Drug Alcohol Depend 2019; 201:260-265. [PMID: 31276986 PMCID: PMC6737934 DOI: 10.1016/j.drugalcdep.2019.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Prescription drug monitoring programs (PDMPs) are state-based databases that contain information about controlled substance prescriptions dispensed by pharmacies. Many states now mandate PDMP use by prescribers, despite unclear effectiveness. We hypothesize that it is possible to improve the interpretability, and hence effectiveness, of PDMPs by enhancing them. METHODS This was a real-time simulation of an enhanced PDMP. Fifty practicing physicians (25 primary care, 25 emergency medicine) were randomized to see three cases with a standard profile or an enhanced profile that included graphical representation of prescriptions and identified risky prescribing patterns. After a two-month washout period, participants were placed in the opposite group. RESULTS Physicians presented with the enhanced profile were more likely to correctly identify patients with multiple providers (97.0% vs. 85.8%, p = 0.002), overlapping opioid and benzodiazepine prescriptions (94.7% vs. 87.5%, p = 0.03), overlapping opioid prescriptions (89.5% vs. 70.8%, p < 0.01), high daily dosages of opioids (99.2% vs. 25.0%, p = 0.02), and traveling to distant pharmacies (79.7% vs. 2.5%, p < 0.01). There was no difference in interpretation time for the three cases (standard profile 657.3 s vs. enhanced profile 686.3 s, p = 0.31). CONCLUSIONS A simulated PDMP with graphical displays and interpretation of findings was, for this cohort of emergency physicians and primary care physicians, associated with an increased ability to determine high-risk features on PDMP profiles.
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Affiliation(s)
- Scott G. Weiner
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, NH-226, Boston, MA 02115 United States
| | - Karen M. Sherritt
- Department of Medicine, The Phyllis Jen Center for Primary Care, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 United States
| | - Zoe Tseng
- Department of Medicine, Brigham and Women's Hospital, 272 Centre Street, Newton, MA 02458, United States.
| | - Jaya Tripathi
- MITRE Corporation, 202 Burlington Road, Bedford, MA 01730, United States.
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Witry MJ, St Marie BJ, Viyyuri BR, Windschitl PD. Factors Influencing Judgments to Consult Prescription Monitoring Programs: A Factorial Survey Experiment. Pain Manag Nurs 2019; 21:48-56. [PMID: 31133408 DOI: 10.1016/j.pmn.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prescription monitoring programs (PMPs) can provide health care professionals with valuable information. However, few studies have explored providers' decision making for accessing PMPs. AIMS This study aimed to identify provider characteristics and situational factors most influencing perceived importance of consulting the PMP for patients in a simulated context. DESIGN The study used a cross-sectional factorial survey. SETTINGS The survey was administered electronically. PARTICIPANTS/SUBJECTS Community pharmacists, advanced practice registered nurses (APRNs), and physicians in Iowa. METHODS Participants were recruited by mail which included a link to the online survey. The survey consisted of demographic questions, eight randomly generated vignettes, and one ranked item. The vignettes described a hypothetical prescription using eight experimental variables whose levels were randomly varied. Respondents evaluated each vignette for importance to access the PMP. Analyses used linear mixed-effects models in R (Version 3.5.0). RESULTS A total of 138 responses were available for multilevel analysis. Women, physicians, and APRNs rated it more important to consult the PMP for a given prescription compared with men and pharmacists. Accessing a PMP was perceived as more important with cash payments, quantity dispensed, suspicion for misuse, hydromorphone and oxycodone prescriptions, and headache. Advancing age, postoperative pain, and anxiety or sleep indications were associated with less importance. CONCLUSIONS Age, indication for prescribing, misuse, and payment mode each independently had greater importance to providers in accessing the PMP. This was the first study to isolate the influence of different controlled substances on how important it was to consult the PMP.
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Affiliation(s)
- Matthew J Witry
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa.
| | | | | | - Paul D Windschitl
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
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Hussain MI, Nelson AM, Polston G, Zheng K. Improving the design of California's prescription drug monitoring program. JAMIA Open 2019; 2:160-172. [PMID: 31984351 DOI: 10.1093/jamiaopen/ooy064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/25/2018] [Accepted: 12/20/2018] [Indexed: 11/12/2022] Open
Abstract
Objective The US CDC identified prescription drug monitoring programs (PDMPs) as a tool to address the contemporary opioid crisis, but few studies have investigated PDMP usability and effectiveness from the users' perspective. Even fewer have considered how practices differ across medical domains. In this study, we aimed to address these gaps, soliciting perspectives on PDMPs from providers contending with the opioid crisis: physicians working in emergency departments (EDs) and pain management clinics. We aimed to provide practical design recommendations to improve PDMP workflow integration, as well as controlled substance history retrieval, interpretation, and decision support. Methods We conducted 16 in-depth semi-structured interviews with practicing emergency and pain physicians regarding their procedures, problems, and proposed solutions surrounding their use of CURES, California's PDMP. We investigated design problems in CURES by combining users' feedback with our usability inspection, drawing upon an extensive body of design literature. Then, we generated alternatives using design methods. Results We found CURES's design did not accommodate the unique information needs of different medical domains. Further, clinicians had trouble accessing CURES and retrieving patients' controlled substance histories, mainly due to usability problems that could be addressed with little technical adjustment. Additionally, CURES rendered patient histories in large, cluttered tables, devoid of overview or context, making interpretation difficult and precarious. Lastly, our interviewees had rarely noticed or used advanced features, such as decision support. Discussion and Conclusion Usability barriers inhibited adoption and effective use. We provide practical recommendations for improving opioid control by way of improving PDMP design, based on interviewees' suggestions and research-based design principles. Our findings have implications for other disciplines, including surgery and primary care.
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Affiliation(s)
- Mustafa I Hussain
- Department of Informatics, University of California, Irvine, Irvine, California, USA
| | - Ariana M Nelson
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, California, USA
| | - Gregory Polston
- Department of Anesthesiology, University of California, San Diego, San Diego, California, USA
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, Irvine, California, USA
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25
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Sood S, Cowdrey A, Bhattarai B, Ayutyanont N, Ramos G, Khosla D, Willows B. Prescription Drug Monitoring Programs: Does the Arizona CSPMP Provide More Information than Routinely Collected in an Inpatient Psychiatric Facility? Subst Use Misuse 2019; 54:106-109. [PMID: 30332337 DOI: 10.1080/10826084.2018.1504082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMPs) have been implemented as tools to help identify misuse of prescription medications. There has been mixed data regarding the efficacy of PDMP, and physician attitudes towards it vary. In an inpatient psychiatric hospital, history of substance use, including prescription medications, and results of urine drug screens (UDS) are obtained during the admission interview. OBJECTIVES The aim was to determine if the substance use history and UDS are sufficient to identify substance use as compared to information obtained by Arizona's Controlled Substance Prescription Monitoring Program (CSPMP) in an inpatient setting. METHODS A prospective chart review was completed on all newly admitted patients to the behavioral units within a 30-day period to identify those that had substance use disorder. CSPMP records were checked for all subjects for patterns of misuse. The test results were not normally distributed, so non-parametric tests were chosen for analyses. RESULTS Of the 220 patients admitted, 127 patients had a substance use diagnosis. Out of the 127 patients, 67(30.5 %) were diagnosed with either opioid, benzodiazepine or amphetamine and stimulant use disorder. Of the 125 (56.8%) patients who had a substance use disorder, the substance abuse diagnosis had been made by the psychiatrist in the medical chart. CSPMP identified only 2 (0.8%) additional patients that were missed during the intake. CONCLUSIONS The CSPMP provided little benefit to improving substance abuse detection when compared with the clinical interview and UDS results. This is attributed to the comprehensive evaluation done during the intake.
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Affiliation(s)
- Shabnam Sood
- a District Medical Group , Phoenix , AZ , USA.,b University of Arizona School of Medicine - Phoenix , Phoenix , AZ , USA.,c Maricopa Integrated Health System , Phoenix , AZ , USA
| | - Alicia Cowdrey
- c Maricopa Integrated Health System , Phoenix , AZ , USA
| | - Bikash Bhattarai
- b University of Arizona School of Medicine - Phoenix , Phoenix , AZ , USA.,c Maricopa Integrated Health System , Phoenix , AZ , USA
| | | | - Gilbert Ramos
- c Maricopa Integrated Health System , Phoenix , AZ , USA
| | - Dhruv Khosla
- c Maricopa Integrated Health System , Phoenix , AZ , USA
| | - Brooke Willows
- b University of Arizona School of Medicine - Phoenix , Phoenix , AZ , USA
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26
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Sun BC, Lupulescu-Mann N, Charlesworth CJ, Kim H, Hartung DM, Deyo RA, John McConnell K. Variations in prescription drug monitoring program use by prescriber specialty. J Subst Abuse Treat 2018; 94:35-40. [PMID: 30243415 DOI: 10.1016/j.jsat.2018.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although prescription drug monitoring programs (PDMPs) have been widely implemented to potentially reduce abuse of prescription opioids, there is limited data on variations in PDMP use by prescriber specialty. Such knowledge may guide targeted interventions to improve PDMP use. METHODS Using data from Washington state Medicaid program, we performed a retrospective cohort study of opioid prescribers and their PDMP queries between Nov 1, 2013 and Oct 31, 2014. PDMP registration was mandatory for emergency physicians, but not for other providers. The unit of analysis was the prescriber. The primary outcome was any prescriber queries of the PDMP. We used multivariate regression models to identify variations in PDMP queries by prescriber specialty, as well as to explore explanatory pathways for observed variations. RESULTS We studied 17,390 providers who prescribed opioids, including 8718 (50%) who were not registered with PDMP, 4767 (27%) who were registered but had no recorded use of the PDMP, and 3905 (23%) PDMP users (queries/user: median 18, IQR 5-64). Compared to general medicine physicians, PDMP use was higher for emergency physicians (OR 1.4, 95%CI: 1.2-1.7), and lower for surgical specialists (OR 0.1, 95%CI: 0.08-0.1), obstetrician-gynecologists (OR 0.2, 95%CI: 0.1-0.2) and dentists (OR 0.4, 95%CI: 0.4-0.5). Higher use by emergency physicians appeared to be mediated by higher registration rates, rather than by provider level predilection to use the PDMP. CONCLUSIONS A minority of opioid prescribers to Medicaid beneficiaries used the PDMP. We identified variations in PDMP use by prescriber specialty. Interventions to increase PDMP queries should target both PDMP registration and PDMP use after registration, as well as specialties with current low use rates.
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Affiliation(s)
- Benjamin C Sun
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States of America.
| | - Nicoleta Lupulescu-Mann
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, United States of America
| | - Christina J Charlesworth
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, United States of America
| | - Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, United States of America
| | - Daniel M Hartung
- College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR, United States of America
| | - Richard A Deyo
- Department of Family Medicine, Department of Medicine, Department of Public Health and Preventive Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, United States of America
| | - K John McConnell
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States of America; Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, United States of America
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Vander Weg MW. Capsule Commentary on Radomski et al.'s Physicians' Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-state Qualitative Study. J Gen Intern Med 2018; 33:1381. [PMID: 29869141 PMCID: PMC6082194 DOI: 10.1007/s11606-018-4515-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mark W Vander Weg
- Iowa City VA Health Care System, Iowa City, IA, USA. .,Department of Internal Medicine, University of Iowa, Iowa City, IA, USA. .,Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
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Sun BC, Lupulescu-Mann N, Charlesworth CJ, Kim H, Hartung DM, Deyo RA, McConnell KJ. Does Prescription Opioid Shopping Increase Overdose Rates in Medicaid Beneficiaries? Ann Emerg Med 2018; 71:679-687.e3. [PMID: 29174833 PMCID: PMC5960419 DOI: 10.1016/j.annemergmed.2017.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/21/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE The link between prescription opioid shopping and overdose events is poorly understood. We test the hypothesis that a history of prescription opioid shopping is associated with increased risk of overdose events. METHODS This is a secondary analysis of a linked claims and controlled substance dispense database. We studied adult Medicaid beneficiaries in 2014 with prescription opioid use in the 6 months before an ambulatory care or emergency department visit with a pain-related diagnosis. The primary outcome was a nonfatal overdose event within 6 months of the cohort entry date. The exposure of interest (opioid shopping) was defined as having opioid prescriptions by different prescribers with greater than or equal to 1-day overlap and filled at 3 or more pharmacies in the 6 months before cohort entry. We used a propensity score to match shoppers with nonshoppers in a 1:1 ratio. We calculated the absolute difference in outcome rates between shoppers and nonshoppers. RESULTS We studied 66,328 patients, including 2,571 opioid shoppers (3.9%). There were 290 patients (0.4%) in the overall cohort who experienced a nonfatal overdose. In unadjusted analyses, shoppers had higher event rates than nonshoppers (rate difference of 4.4 events per 1,000; 95% confidence interval 0.8 to 7.9). After propensity score matching, there were no outcome differences between shoppers and nonshoppers (rate difference of 0.4 events per 1,000; 95% confidence interval -4.7 to 5.5). These findings were robust to various definitions of opioid shoppers and look-back periods. CONCLUSION Prescription opioid shopping is not independently associated with increased risk of overdose events.
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Affiliation(s)
- Benjamin C Sun
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
| | | | | | - Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
| | - Daniel M Hartung
- College of Pharmacy, Oregon State University, Oregon Health & Science University, Portland, OR
| | - Richard A Deyo
- Department of Family Medicine, Department of Medicine and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR
| | - K John McConnell
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR; Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
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Larson MJ, Browne C, Nikitin RV, Wooten NR, Ball S, Adams RS, Barth K. Physicians report adopting safer opioid prescribing behaviors after academic detailing intervention. Subst Abus 2018; 39:218-224. [PMID: 29608412 DOI: 10.1080/08897077.2018.1449175] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background This study evaluated an educational intervention intended to increase physicians' use of patient prescription history information from the state prescription monitoring program (PMP) and their adoption of clinical behaviors consistent with opioid prescription guidelines to reduce patient risk. Methods Physician volunteers (n = 87) in community practices and Veterans Administration medical settings in South Carolina received an office-based, individualized, educational intervention (Academic Detailing) from a trained pharmacist who promoted three key messages about safer opioid prescribing. Physicians were registered for the state PMP, guided through retrieving patient information from the PMP, and given patient-centered materials. Physicians consented to completing web-surveys; 68 (78%) completed follow-up surveys on average 12.2 weeks post-intervention. Results Of 43 respondents who did not use the PMP before the intervention, 83% adopted PMP use. Self-reports also revealed a significant increase in frequency of the following behaviors: 1) using patient report information from the PMP, 2) using a standardized scale to monitor pain intensity and interference with daily functioning, and 3) issuing orders for urine toxicology screens for patients maintained long-term on opioids. Conclusions The intervention was effective in promoting physician adoption of prescribing behaviors intended to reduce risks associated with prescription opioids. The self-report findings of this study should be confirmed by analysis using data on the number of queries submitted to the state's PMP. The present study suggests that a single academic detailing visit may be an effective tool for increasing physician voluntary registration and utilization of data on patients' prescription history contained in a state PMP.
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Affiliation(s)
- Mary Jo Larson
- a Mary Jo Larson is senior scientist and senior lecturer, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University , Waltham MA
| | - Cheryl Browne
- b Cheryl Browne is an independent evaluation consultant in Somerville , MA
| | - Ruslan V Nikitin
- c Ruslan V. Nikitin was a research associate at Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University , Waltham MA
| | - Nikki R Wooten
- d Nikki R. Wooten is an assistant professor and chair, military specialization, College of Social Work, University of South Carolina, Columbia SC . Dr. Wooten is also a lieutenant colonel in the U. S. Army Reserve
| | - Sarah Ball
- e Sarah Ball is a research assistant professor, Division of General Internal Medicine and Geriatrics, College of Medicine, Medical University of South Carolina , Charleston, SC
| | - Rachel Sayko Adams
- f Rachel Sayko Adams is a scientist at the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University , Waltham MA
| | - Kelly Barth
- g Kelly Barth is associate professor, Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina , Charleston, SC
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Hawk K, D'Onofrio G, Fiellin DA, Chawarski MC, O'Connor PG, Owens PH, Pantalon MV, Bernstein SL. Past-year Prescription Drug Monitoring Program Opioid Prescriptions and Self-reported Opioid Use in an Emergency Department Population With Opioid Use Disorder. Acad Emerg Med 2018; 25:508-516. [PMID: 29165853 DOI: 10.1111/acem.13352] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/11/2017] [Accepted: 11/16/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug-related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied. OBJECTIVES The objective was to evaluate a relationship between PDMP opioid prescription records and self-reported nonmedical opioid use of prescription opioids in a cohort of opioid-dependent ED patients enrolled in a treatment trial. METHODS PDMP opioid prescription records during 1 year prior to study enrollment on 329 adults meeting Diagnostic and Statistical Manual IV criteria for opioid dependence entering a randomized clinical trial in a large, urban ED were cross-tabulated with data on 30-day nonmedical prescription opioid use self-report. The association among these two types of data was assessed by the Goodman and Kruskal's gamma; a logistic regression was used to explore characteristics of participants who had PDMP record of opioid prescriptions. RESULTS During 1 year prior to study enrollment, 118 of 329 (36%) patients had at least one opioid prescription (range = 1-51) in our states' PDMP. Patients who reported ≥15 of 30 days of nonmedical prescription opioid use were more likely to have at least four PDMP opioid prescriptions (20/38; 53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and having health insurance were significantly more represented in the PDMP (p < 0.05 for both). CONCLUSION PDMPs may be helpful in identifying patients with certain aberrant drug-related behavior, but are unable to detect many patients with opioid use disorder. The majority of ED patients with opioid use disorder were not captured by the PDMP, highlighting the importance of using additional methods such as screening and clinical history to identify opioid use disorders in ED patients and the limitations of PDMPs to detect opioid use disorders.
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Affiliation(s)
- Kathryn Hawk
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Gail D'Onofrio
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - David A. Fiellin
- Department of Emergency Medicine Yale School of Medicine New Haven CT
- Department of Internal Medicine Yale School of Medicine New Haven CT
- Yale School of Public Health New Haven CT
| | | | | | - Patricia H. Owens
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | | | - Steven L. Bernstein
- Department of Emergency Medicine Yale School of Medicine New Haven CT
- Yale School of Public Health New Haven CT
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31
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Leichtling GJ, Irvine JM, Hildebran C, Cohen DJ, Hallvik SE, Deyo RA. Clinicians' Use of Prescription Drug Monitoring Programs in Clinical Practice and Decision-Making. PAIN MEDICINE 2018; 18:1063-1069. [PMID: 27794549 DOI: 10.1093/pm/pnw251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives Little is known about clinicians' use of prescription drug monitoring program (PDMP) profiles in decision-making. The objective of this qualitative study was to understand how clinicians use, interpret, and integrate PDMP profiles with other information in making clinical decisions. Design Qualitative interviews of clinician PDMP users. Setting Oregon registrants in the state's PDMP. Subjects Thirty-three clinicians practicing in primary care, emergency medicine, pain management, psychiatry, dentistry, and surgery. Methods We conducted semistructured telephone interviews with PDMP users. A multidisciplinary team used a grounded theory approach to identify patterns of PDMP use and how PDMP profiles influence clinical decisions. Results PDMP use varied from consistent monitoring to checking the PDMP only on suspicion of misuse, with inconsistent use reported particularly among short-term prescribers. Primary care clinicians reported less routine use with existing pain patients than with new patients. In response to worrisome PDMP profiles with new patients, participants reported declining to prescribe, except in the case of acute, verifiable conditions. Long-term prescribers reported sometimes continuing prescriptions for existing patients depending on perceived patient intent, honesty, and opioid misuse risk. Some long-term prescribers reported discharging patients from their practices due to worrisome PDMP profiles; others expressed strong ethical grounds for retaining patients but discontinuing controlled substances. Conclusion Greater consistency is needed in use of PDMP in monitoring existing patients and in conformity to guidelines against discharging patients from practice. Research is needed to determine optimal approaches to interpreting PDMP profiles in relation to clinical judgment, patient screeners, and other information.
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Affiliation(s)
| | | | | | | | | | - Richard A Deyo
- Departments of Family Medicine.,Medicine.,Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon.,Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon, USA
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Sun BC, Charlesworth CJ, Lupulescu-Mann N, Young JI, Kim H, Hartung DM, Deyo RA, McConnell KJ. Effect of Automated Prescription Drug Monitoring Program Queries on Emergency Department Opioid Prescribing. Ann Emerg Med 2018; 71:337-347.e6. [PMID: 29248333 PMCID: PMC5820164 DOI: 10.1016/j.annemergmed.2017.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE We assess whether an automated prescription drug monitoring program intervention in emergency department (ED) settings is associated with reductions in opioid prescribing and quantities. METHODS We performed a retrospective cohort study of ED visits by Medicaid beneficiaries. We assessed the staggered implementation (pre-post) of automated prescription drug monitoring program queries at 86 EDs in Washington State from January 1, 2013, to September 30, 2015. The outcomes included any opioid prescribed within 1 day of the index ED visit and total dispensed morphine milligram equivalents. The exposure was the automated prescription drug monitoring program query intervention. We assessed program effects stratified by previous high-risk opioid use. We performed multiple sensitivity analyses, including restriction to pain-related visits, restriction to visits with a confirmed prescription drug monitoring program query, and assessment of 6 specific opioid high-risk indicators. RESULTS The study included 1,187,237 qualifying ED visits (898,162 preintervention; 289,075 postintervention). Compared with the preintervention period, automated prescription drug monitoring program queries were not significantly associated with reductions in the proportion of visits with opioid prescribing (5.8 per 1,000 encounters; 95% confidence interval [CI] -0.11 to 11.8) or the amount of prescribed morphine milligram equivalents (difference 2.66; 95% CI -0.15 to 5.48). There was no evidence of selective reduction in patients with previous high-risk opioid use (1.2 per 1,000 encounters, 95% CI -9.5 to 12.0; morphine milligram equivalents 1.22, 95% CI -3.39 to 5.82). The lack of a selective reduction in high-risk patients was robust to all sensitivity analyses. CONCLUSION An automated prescription drug monitoring program query intervention was not associated with reductions in ED opioid prescribing or quantities, even in patients with previous high-risk opioid use.
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Affiliation(s)
- Benjamin C Sun
- Center for Policy Research-Emergency Medicine, Oregon Health & Science University, Portland, OR.
| | | | | | - Jenny I Young
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
| | - Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
| | - Daniel M Hartung
- College of Pharmacy, Oregon Health & Science University, Portland, OR; College of Pharmacy, Oregon State University, Portland, OR
| | - Richard A Deyo
- Department of Family Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR; Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR
| | - K John McConnell
- Center for Policy Research-Emergency Medicine, Oregon Health & Science University, Portland, OR; Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
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Abstract
BACKGROUND Prescription opioid abuse has rapidly increased in recent years and is now considered a national epidemic by the United States government. Community pharmacies are at the forefront of opioid abuse, given their role in dispensing opioid prescriptions. Despite this role, however, there are few known guidelines to help community pharmacists navigate the process of detecting and managing prescription opioid abuse. OBJECTIVES To develop and evaluate a candidate guideline, based on clinical experience and existing literature, to help community pharmacists monitor and manage potential opioid prescription abuse. METHODS We developed an algorithm based on literature and expert advice. The algorithm was reviewed by two discussion groups and six community pharmacy stakeholders through in-depth interviews, and revised based on feedback. RESULT Key themes identified from the discussions were that the algorithm should encompass the following: (1) start with ensuring authenticity of the prescription; (2) employ state prescription drug monitoring program (PDMP) as a primary screening tool to detect those at risk for prescription opioid abuse; (3) employ the additional abuse detection steps of clinical profile review and observation of the person picking up the prescription; (4) involve protocols of sharing concerns with the patient, making contact with the prescriber, and/or return of the prescription if appropriate, and (5) be easy to follow and significantly enhanced through color coding. CONCLUSION Future steps should explore the feasibility of using the algorithm in different community settings, and determine the algorithm's impact on the number of prescription opioids dispensed and the number of individuals referred to prescribers for discussions about possible prescription opioid abuse.
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Shcherbakova N, Tereso G, Spain J, Roose RJ. Treatment Persistence Among Insured Patients Newly Starting Buprenorphine/Naloxone for Opioid Use Disorder. Ann Pharmacother 2018; 52:405-414. [DOI: 10.1177/1060028017751913] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Persistence with medication-assisted therapy among patients with opioid use disorder has been associated with reduced likelihood of illicit opioid use. Objective: We aimed to describe treatment persistence and identify factors associated with 1-year persistence among insured patients newly initiating buprenorphine-containing pharmacotherapy. Methods: The retrospective observational cohort included employer-sponsored and managed Medicaid patients newly started on buprenorphine-containing therapy between June 30, 2010, and January 1, 2015. Persistence was measured as both a continuous and dichotomous variable (proportion of patients persistent for 1 year). Multivariable logistic regression analysis was used to identify factors associated with 1-year persistence. Results: A total of 302 patients met inclusion criteria. The median [range] number of treatment episodes was 1 [1-4]. Mean number of days on therapy during the first episode was 206 (SD = 152) days, with 40.4% (n = 122) of patients persisting for 1 year. Presence of concomitant fills of prescription opioid analgesics (odds ratio [OR] = 0.25; 95% CI = 0.12-0.51), being in care of an addiction specialist (OR = 0.40; 95% CI = 0.21-0.76), and Medicaid insurance coverage (OR = 0.33; 95% CI = 0.13-0.84) were significantly and negatively associated with 1-year persistence. There was also a strong inverse relationship between persistence and inpatient hospitalization (OR = 0.30; 95% CI = 0.12-0.76). Conclusions: Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.
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Affiliation(s)
| | - Gary Tereso
- Health New England Inc, Springfield, MA, USA
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35
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Prescription drug monitoring program design and function: A qualitative analysis. Drug Alcohol Depend 2017; 180:395-400. [PMID: 28978492 DOI: 10.1016/j.drugalcdep.2017.08.040] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Opioid-related overdose deaths are a major public health challenge. Forty-nine states have implemented Prescription Drug Monitoring Programs (PDMPs) that collect information about individuals' prescription medications. Little is known about state governments' implementation of PDMPs. We conducted semi-structured interviews with PDMP staff, law enforcement officials, and administrative agency employees to learn about their attitudes and experiences with PDMPs. METHODS From May 2015 to June 2016, we conducted 37 semi-structured interviews with state actors in four states. Questions focused on interviewees' perceptions about PDMP goals, home agency characteristics, and future PDMP initiatives. States were selected purposively. Interviewees were identified through purposive and snowball sampling. RESULTS Interviewees identified key PDMP goals as: improve patient treatment decisions; influence prescribing practices; assist in the identification of "doctor shoppers"; and serve as a tool for law enforcement. Interviewees identified the following characteristics as key for a PDMP's home agency: regulatory and enforcement authority; intra- and inter-agency collaboration; and commitment to data quality and protection. Interviewees identified three promising areas for future PDMP efforts: data sharing and analysis; integration of PDMP data with electronic medical records; and training for current and potential PDMP users. CONCLUSIONS Our findings reveal areas that states may want to prioritize, including improving prescribers' knowledge and use of the PDMP as well as fostering inter-agency collaborations that include PDMP staff. By capitalizing on these opportunities, state governments may improve the effectiveness of their PDMPs, potentially making them more useful tools to curb the morbidity and mortality associated with opioid use disorders.
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36
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Sun BC, Lupulescu-Mann N, Charlesworth CJ, Kim H, Hartung DM, Deyo RA, John McConnell K. Impact of Hospital "Best Practice" Mandates on Prescription Opioid Dispensing After an Emergency Department Visit. Acad Emerg Med 2017; 24:905-913. [PMID: 28544288 PMCID: PMC5552416 DOI: 10.1111/acem.13230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/06/2017] [Accepted: 05/15/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Washington State mandated seven hospital "best practices" in July 2012, several of which may affect emergency department (ED) opioid prescribing and provide a policy template for addressing the opioid prescription epidemic. We tested the hypothesis that the mandates would reduce opioid dispensing after an ED visit. We further assessed for a selective effect in patients with prior risky or chronic opioid use. METHODS We performed a retrospective, observational analysis of ED visits by Medicaid fee-for-service beneficiaries in Washington State, between July 1, 2011, and June 30, 2013. We used an interrupted time-series design to control for temporal trends and patient characteristics. The primary outcome was any opioid dispensing within 3 days after an ED visit. The secondary outcome was total morphine milligram equivalents (MMEs) dispensed within 3 days. RESULTS We analyzed 266,614 ED visits. Mandates were associated with a small reduction in opioid dispensing after an ED visit (-1.5%, 95% confidence interval [CI] = -2.8% to -0.15%). The mandates were associated with decreased opioid dispensing in 42,496 ED visits by patients with prior risky opioid use behavior (-4.7%, 95% CI = -7.1% to -2.3%) and in 20,238 visits by patients with chronic opioid use (-3.6%, 95% CI = -5.6% to -1.7%). Mandates were not associated with reductions in MMEs per dispense in the overall cohort or in either subgroup. CONCLUSIONS Washington State best practice mandates were associated with small but nonselective reductions in opioid prescribing rates. States should focus on alternative policies to further reduce opioid dispensing in subgroups of high-risk and chronic users.
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Affiliation(s)
- Benjamin C Sun
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR
| | | | | | - Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR
| | - Daniel M Hartung
- College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR
| | - Richard A Deyo
- Department of Family Medicine, Department of Medicine, Department of Public Health and Preventive Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR
| | - K John McConnell
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR
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Evans TI, Hadland SE, Clark MA, Green TC, Marshall BDL. Factors associated with knowledge of a Good Samaritan Law among young adults who use prescription opioids non-medically. Harm Reduct J 2016; 13:24. [PMID: 27455957 PMCID: PMC4960738 DOI: 10.1186/s12954-016-0113-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background To date, no studies have examined the extent of knowledge and perceptions of Good Samaritan Laws (GSLs) among young adults who engage in non-medical prescription opioid (NMPO) use. We sought to determine awareness of and factors associated with knowledge of Rhode Island’s Good Samaritan Law (RIGSL) among young adult NMPO users. Findings We compared the sociodemographic and overdose-related characteristics of participants who were aware and unaware of the RIGSL and determined independent correlates of knowledge of the RIGSL via modified stepwise logistic regression. Among 198 eligible participants, 15.7 % were black, 62.1 % white, and 20.7 % mixed or other race. The mean age was 24.5 (SD = 3.2) and 129 (65.2 %) were male. Fewer than half (45.5 %) were aware of the RIGSL; nonetheless, the majority (95.5 %) reported a willingness to call 911 in the event of an overdose. Knowledge of the RIGSL was associated with older age, white race, a history of incarceration, a history of injection drug use, lifetime heroin use, ever witnessing or experiencing an overdose, having heard of naloxone, knowledge of where to obtain naloxone, and experience administering naloxone (all p < 0.05). In the final explanatory regression model, lifetime injection drug use, having heard of naloxone, and knowledge of where to obtain naloxone were independently associated with awareness of the RIGSL. Conclusions Fewer than half of NMPO users surveyed knew of the RIGSL. Targeted harm reduction education is needed to address a vulnerable population of NMPO users who have not initiated injection drug use and are unaware of naloxone. Additional research is needed to determine how the effectiveness of GSLs could be improved to prevent overdose deaths among young adults.
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Affiliation(s)
- Tristan I Evans
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Melissa A Clark
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.,Department of Quantitative Health Sciences and Center for Health Policy and Research, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.,Department of Emergency Medicine, Boston University School of Medicine, 771 Albany Street, Room 1208, Boston, MA, 02118, USA.,Rhode Island Hospital, The Warren Alpert School of Medicine of Brown University, 55 Claverick Street, Providence, RI, 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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