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How Does Use of a Prescription Monitoring Program Change Medical Practice?

Authors


  • Disclosures: The authors have no conflicts of interest or financial relationships with any company whose products may be related to the topic of this article to disclose.

  • Funding: This work was supported by a grant from the Centers for Disease Control and Prevention (CDC) (R21CE001846-01 Green [PI]).

  • All authors have significantly contributed to the design of the study, interpretation of data, drafting/revising the article for important intellectual content, and will be involved in the final approval of any published version. The concept, design, and analysis of the study were accomplished by the first author.

Traci C. Green, MSc, PhD, 593 Eddy St., 111 Plain St. Building, Rm. 111, Providence, RI 02903, USA. Tel: 401-444-3845 (office); Fax: 401-444-5040; E-mail: traci.c.green@gmail.com.

Abstract

Objectives.  The objectives of this study were to test for differences in prescription monitoring program (PMP) use between two states, Connecticut (CT) and Rhode Island (RI), with a different PMP accessibility; to explore use of PMP reports in clinical practice; and to examine associations between PMP use and clinician's responses to suspected diversion or “doctor shopping” (i.e., multiple prescriptions from multiple providers).

Design, Setting, Subjects.  From March to August 2011, anonymous surveys were emailed to providers licensed to prescribe Schedule II medications in CT (N = 16,924) and RI (N = 5,567).

Outcome Measures.  PMP use, use of patient reports in clinical practice, responses to suspected doctor shopping, or diversion.

Results.  Responses from 1,385 prescribers were received: 998 in CT and 375 in RI. PMP use was greater in CT, where an electronic PMP is available (43.9% vs 16.3%, χ2 = 85.2, P < 0.0001). PMP patient reports were used to screen for drug abuse (36.2% CT vs 10.0% RI, χ2 = 60.9, P < 0.0001) and detect doctor shopping (43.9% CT vs 18.5% RI, χ2 = 68.3, P < 0.0001). Adjusting for potential confounders, responses by PMP users to suspicious medication use behavior were more likely to entail clinical response (i.e., refer to another provider odds ratio, OR, 1.75 [95% confidence interval, CI, 1.10, 2.80]; screen for drug abuse OR 1.93 [1.39, 2.68]; revisit pain/treatment agreement OR 1.97 [1.45, 2.67]; conduct urine screen OR 1.82 [1.29, 2.57]; refer to substance abuse treatment OR 1.30 [0.96, 1.75]) rather than legal intervention (OR 0.45 [0.21, 0.94]) or inaction (OR 0.09 [0.01, 0.70]).

Conclusions.  Prescribers' use of an electronic PMP may influence medical practice, especially opioid abuse detection, and is associated with clinical responses to suspected doctor shopping or diversion.

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