A Data Application for Monitoring Opioid Prescribing

This monthly blog highlights and discuss emerging trends and challenges related to healthcare data and its ever changing life cycle.


By Barbara Ryznar, RPh, MSHI, RHIA, CHDA, CPHI, CPHIMS, CAPM

 

There is a wide variety of addictive substances available to humans today—from the socially acceptable to the criminal. Psychoactive substances include a vast spectrum of entities, including caffeine, alcohol, tobacco, and many drugs both legal and illegal. The rapid rise of the use and abuse of opioid drugs—commonly referred to as the opioid crisis or opioid epidemic—and the association high rate of mortality from opioid abuse and addiction, has grasped public attention and led to the declaration of a National Public Health Emergency.

The over-prescription of opioid drugs and subsequent diversion of legally obtained opioids by the patients have been identified as contributing factors in the drug abuse crisis; simply put, the drugs are relatively easily available for misuse. With effective application of appropriate health information technologies, aggregated, organized, and retrievable data can be harnessed as a powerful tool to combat this drug abuse. The introduction of State Prescription Drug Monitoring Programs (PDMPs) grants this data availability with a tool that has the potential to make an impact on the supply side of legal opioids in preventing diversion and abuse.

Data aggregated from electronically transmitted pharmacy claims and regulatory reports submitted by pharmacies present an opportunity to bring useful data together and available for making informed decisions. For example, the PDMP can be utilized as a method to identify “doctor shoppers” (drug seekers who attempt to acquire narcotics from multiple providers) or physicians or pharmacists who may be deviating from standards of practice. This database is also available as a tool for utilization by healthcare professionals at the point of prescribing and dispensing. The availability of a current and complete patient-specific history of narcotics and other controlled substance use offers clinical decision support in real time.

The prescriber can then exercise professional judgment in the prescribing decision process, and the dispenser becomes an additional checkpoint. The system also monitors its users as a password is required, and an audit trail is created from search activities. This can verify that the tool is being assessed and utilized appropriately for its purposes. In some states, PDMP query is mandatory for specific circumstances. PDMP use is a means of monitoring and controlling the supply side of the prescription opioid problem at each step of the prescription process, all the way until the prescribed substance reaches the patient’s control.

While prescription claims processing serves to provide safety alerts such as “too soon to fill” circumstances, and can suggest overuse when multiple pharmacies and multiple prescriptions are identified, customers who bypass the insurance processing by paying cash have previously been able to avoid these safeguards due to lack of data sharing among pharmacy providers. Previously, physician or other prescribing providers had no easy way to access the data on a patient’s prescription use from other providers. The medication reconciliation process relies on patient self-reporting, which allows for omission of information. The PDMP has closed these gaps in the processes by combining sources and making the data available for multiple users in regulatory, clinical, and analytical roles.

For more information or for detail regarding your state PDMP initiatives, consult the PDMP TTAC at http://www.pdmpassist.org/content/pdmp-maps-and-tables.

 

Barbara A. Ryznar is a community pharmacist at a Medicine Shoppe Pharmacy and a part-time adjunct instructor in the MSHI program at University of Cincinnati.

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