Evaluation of the N.C. Prescription

Transcription

1 Evaluation of the N.C. Prescription Drug Monitoring Program 2013 National Meeting of the Safe States Alliance and SAVIR MarianaGarrettson Garrettson, MPH Chris Ringwalt, DrPH UNC Injury Prevention Research Center William Bronson, Project Officer NC Department of Health and Human Services

2 Source of support Funding for this study has been provided through a contract with the NC Department of Health and Social Services, Division of Mental Health, Developmental Disabilities and Substance Abuse Services, funded by Grant # 2009 PM BX 0008 awarded by the Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice. Neither the U.S. Department of Justice nor any of its components operate, control are responsible for, or necessarily endorse this report (including, without limitation, its content, technical infrastructure, and policies, and any services or tools provided).

3 What is a Prescription Drug Monitoring Program (PDMP)? To collect data on prescription drugs as they are dispensed and to make these data available for various uses, including patient care, public health surveillance, and law enforcement investigations relating to drug diversion and insurance fraud. All 50 states have enacted PDMPlegislation and 41 have operational programs in place

4 Mandate of the NC Controlled Substances Reporting System (CSRS) improve the State s ability to identify controlled substance abusers or misusers and refer them for treatment, and to identify and stop diversion of prescription drugs in an efficient and cost effective manner that will not impede the appropriate medical utilization of licit controlled substances.

5 NC CSRS Timeline 2005: Legislature establishes CSRS August 2008: Pharmacies report bimonthly June 2011 June 2012: Evaluation conducted July 1, 2007: System starts: pharmacies report monthly January 2012: Pharmacies report weekly January 2013: Legislation to update system proposed

6 Two part study 1. User survey 2. Impact analysis of three years of data

7 Research Questions: Part 1 1. Among those not registered to use the system, why are they not registered? 2. Among those who are registered and are using the system: a) what htti triggers them to make a query on a patient? b) how has their use of the system changed their practice?

8 Part I: Prescriber and Dispenser Surveys (convenience samples, 2012) Prescribers Sample sources: CSRS vendor (registered prescribers only) N.C. Medical Society (all prescribers who gave permission) Respondents: N=1462 Dispensers Sample source: N.C. Board of Pharmacy (all pharmacists) Respondents: N=1703

9 Results of Prescriber Survey

10 Why have you NOT registered? Why have you NOT registered? (N=202) Did not know about it I am too busy to look up patient information. I do not prescribe controlled substances. No time to register ('haven't gotten around to it') I tried to enroll but I never heard back. 5 I use someone else's log in. 4 4 Does not apply to my setting 4 1. I did not I do have know Internet access about at work. it 2. I do Misperception not anticipate (thought it was only for ) that I would ever use the system I tried to enroll but CSRS crashed my computer. 3. I am too busy to look up patient information Rely on other information sources (e.g. pharmacists) 4. It does not seem worth my time I do not have an address that only I can access. 5. I do not prescribe controlled substances

11 Reasons that prescribers query the CSRS 1. Patient behavior suggests possible addiction or substance abuse 2. Requests for early refills of controlled substances 3. Request specific drugs 4. Long term prescription for controlled substance 5. Known history of addiction

12 Effects on clinical practice

13 Effects on clinical practice (cont.)

14 Results of Pharmacist Survey

15 Reasons pharmacists have not registered 1. I did not know about it 2. I do not anticipate that I would ever use the system 3. I do not have a DEA number 4. I do not dispensecontrolled substances 5. I do not have internet access at work

16 Reasons for which pharmacists query the CSRS 1. Prescription profile suggests addiction, abuse 2. Requests for early refills 3. Behavior suggests possible addiction or abuse 4. New patients 5. Specific personal knowledge 6. Physical appearance 7. Dispensing i any controlled substance bt 8. Long term prescription for controlled substance

17 Contacting Prescribers about Patients Have you ever used information from the CSRS when you called a prescriber about a patient? (N=482) Didthe prescriberchange change the prescription? (N=390)

18 Key findings from Surveys Continued lack of awareness of the system among prescribers and pharmacists Main reasons for querying the system are appropriate, focus on abuse Use of the system increases prescribers : ability to identify potential abusers confidence in writing and denying prescriptions Both prescribers and pharmacists report using the system to facilitate communication between groups

19 PART II: Analysis of CSRS data

20 Research Questions To what extent has the CSRS : Enhanced the identification of misusers and abusers of controlled substances Increased the extent to which abusers and misusers of controlled substances are referred to treatment Impeded appropriate medical utilization of licit controlled substances Identified and decreased the diversion of prescription medications

21 Methods 3 years of data ( ) Divided for descriptive purposes into 6 6 month blocks (identified as Spring and Fall) Definitionof of at risk for overdose : patients with prescriptions: prescribed by 4+ prescribers AND dispensed by 4+ pharmacies WITHIN any 6 month period Utilization by providers measured as number of days in which queries were made

22 Utilizers querying the NC CSRS, Number of utilizers S 2009 F 2010 S 2010 F 2011 S 2011 F

23 Average number prescriptions for a controlled substance/patient, Mean # prescriptions pesc pto s S 2009 F 2010 S 2010 F 2011 S 2011 F

24 Drug seeking behaviors Dramatic decrease in patients: 15 prescribers AND 15 pharmacists in 6 months 10 prescribers AND 10 pharmacists in 6 months No change in numbers of patients: Identified by current NC criterion for unusual pattern (10 prescribers OR 5 pharmacists in 3 months) At high risk for overdose (4/4 prescribers AND pharmacists in 6 months)

25 Prescriptions written in N.C. for Benzodiazepines i and Opioids, id S F 2010 S 2010 F 2011 S 2011 F 0 Benzodiazepines Opioids

26 Prescriptions written in N.C. for treatment of opioid iddependence, d , ,914 82, S 70, F 59, S 45, F S F 0 Buprenorphine

27 CSRS use associated with patients receiving Bupenorphine

28 Key Findings Steady increase in providers registered for and using thecsrs However, the total number registered, as a proportion of all providers who are eligible to register for the CSRS (30%), remains low. CSRS has not decreased legitimate prescribing. Reductions in # patients meeting strictest drug seeking definition Consistent CSRS utilization strongly associated with the likelihood that high risk patients receive opioid iddependence d treatment

29 Full report can be downloaded from:

30 Like to know more? Contact information: Mariana Garrettson, MPH Injury Prevention Research Center University of North Carolina