PDMP Tools to Identify Red Flag Situations

Transcription

1 PDMP Tools to Identify Red Flag Situations Prescription Drug Monitoring Programs CBI Baltimore, MD February 7, 2017 Grant Carrow, Ph.D. Project Consultant The Heller School for Social Policy and Management Brandeis University

2 Objectives Use PDMP data analysis tools to Promote safe prescribing and dispensing Identify patients potentially at-risk for non-medical use, abuse or drug diversion Analyze prescriber prescribing activity Detect potential abuse, waste and fraud

3 Benefits of PDMP Data Analysis Tools Leverage PDMP databases beyond patient lookups Increase efficiency of PDMP identification of atrisk patients Enable prescriber evaluation of practice Provide additional value to incentivize increased clinical use of PDMPs

4 Recent Resources on Red Flags NABP consensus document on red flag warning signs related to prescribing and dispensing controlled substances 1 DEA decision and order on pharmacy failure to respond to red flags 2 Enabling and requiring pharmacist use of PDMP data: Kroger s access in workflow solution 3 1 National Association of Boards of Pharmacy, Drug Enforcement Administration, Federal Register, Vol 81, No. 218, Nov. 10, Brandeis University, Dec. 2016

5 Limitations of PDMP Data Analysis Tools PDMPs can only help address a subset of abuse, waste and fraud (e.g, multiple provider episodes, early refills, prescription forgery, inappropriate prescribing and dispensing) Red flags are only potential warning signs indicating a need for additional review Thresholds for at-risk patients or providers not formally validated nor standardized among PDMPs

6 PDMP Basic Summary Analyses Basic summary analyses provided with some PDMP reports (i.e., patient prescription history reports for controlled substances) Numbers of patient s controlled substance prescriptions [by type] for reporting period Number of patient s prescribers of controlled substances for reporting period Number of patient s dispensers of controlled substances for reporting period

7 PDMP Enhanced Analyses Calculation of daily morphine equivalent dose (MED, or morphine milligram equivalents, MME) Unsolicited (proactive) reports or alerts Patient risk scores (e.g., NARxCHECK ) Prescriber prescribing history (self look-up) Prescriber report cards Notifications of at-risk providers PDMP data dashboards

8 Calculation of Daily MED Many PDMP reports provide active daily MED PDMP could flag a patient if a threshold is exceeded (e.g., KY) PDMP could provide a list of a provider s patients whose daily MED has exceeded a threshold (e.g., CA, WI)

9 9 Unsolicited Reports Unsolicited reports or alerts can leverage PDMP database to identify patients at risk Healthcare provider can be notified outside of scheduled office visit or lookup

10 10 Unsolicited Reports Questionable activity (e.g., multiple provider episode, early refills) Paper report, electronic alert Peer-to-peer alert (e.g. IN) States differ in thresholds, frequency of alerts A subset of PDMPs are engaged in unsolicited reporting; states differ on recipients of reports Extent of use of unsolicited reports: o In 2012 Q1-Q2, 12 BJA grantee states had < 1 unsolicited report per prescriber with 1 c.s. Rx 1 o In 2013, 30 BJA grantee states collectively sent 39,210 unsolicited reports to prescribers and 11,831 to dispensers (0.24% and 0.14%, respectively, of all intrastate reports) 2 1 Brandeis University, Bureau of Justice Assistance, 2014

11 Number of PDMPs Number of PDMPs Engaged in Solicited and Unsolicited Reporting Solicited Reports Unsolicited Reports 10 0 Prescribers Recipients Dispensers Source: Data from Brandeis University, 2016

12 Unsolicited Report Criteria Criterion Number of PDMPs (n = 13) Multiple provider episode threshold 12 Morphine equivalent dose threshold 2 Concurrent opioids and benzodiazepines 2 Long-term opioid therapy 2 Early refills 1 Multiple same-day prescriptions 1 Number of prescriptions filled above threshold 1 Sources: Data from Brandeis University, 2016; California PDMP/CURES; Wisconsin epdmp

13 Prescriber Tools Prescriber prescribing history (self-lookup) Prescriber report card o Provides individualized data comparing a practitioner s prescribing to peer norms Notifications of at-risk prescribers o E.g., high proportion of patients with multiple provider episodes or prescribed both opioids and benzodiazepenes

14 Data Dashboards and Reports Provide PDMP data at state and county level on o prescribing and dispensing trends o populations of at-risk patients o populations of at-risk prescribers and dispensers Provide perspective on extent of potential prescription drug misuse, abuse and diversion Underscore healthcare provider roles in helping to address epidemic

15 Potential Barriers to Adoption Underutilization of PDMPs Time constraints Lack of integration with clinical workflow Lack of integration with health IT (e.g., EHRs) Lack of information and/or knowledge of system features and capabilities Lack of guidance information on data use Technical and logistical issues Implementation time, costs

16 Some Future Considerations Optimize use of PDMPs Integration of PDMPs with health IT and clinical workflow Clinician-defined alert parameters (e.g., thresholds) Education on use of enhanced PDMP data analysis tools Use of PDMP data in clinical decision support systems

17 Contact Information Grant Carrow, Ph.D. Project Consultant Brandeis University