Provider Education & Utilization Initiatives Alliance of States with PMPs East Regional Meeting Baltimore, MD April 5, 2011 Massachusetts Department of Public Health MA Prescription Monitoring Program
MA Prescription Monitoring Program Background Benefits of Utilization Current Initiatives to Increase Utilization Education on Recent Regulations Provider Education on Use of PMP Information Plans for Future
MA PMP Overview of Current Program Established by joint regulations Drug Control Program Board of Registration ti in Pharmacy Collects data on Schedule II - V (e.g., narcotics, stimulants, t sedatives) prescriptions dispensed d by community, clinic and outpatient pharmacies weekly (since Jan 2011) 3.5 million Schedule II prescriptions monitored in FY 10
MA PMP Overview of Current Program cont. Data reviewed and analyzed by PMP staff Solicited and Unsolicited Reports two user groups regulatory boards; law enforcement health care providers Medical Review Group (physicians, dentists, pharmacists) provides advice and consultation PMP Advisory Council advises on protocols and implementation
MA PMP Utilization Benefits Wider use of the PMP will promote (1) heightened awareness of potential for drug abuse or diversion, (2) need to screen for risk factors: past cocaine, alcohol, cannabis use; lifetime history of substance use disorder; family history of substance abuse; history of legal problems involving drug or alcohol abuse; tobacco dependence; history severe depression or anxiety Attribution: Daniel Alford, MD, MPH, Associate Professor of Medicine, Boston,,,, University School of Medicine, Boston Medical Center
MA PMP Utilization Initiatives Current Targeted enrollment process Live enrollment at programs, conferences In-person trainings Promotion in MA CSR renewals/recalls
MA PMP Utilization Initiatives Current cont. Provider Champions MA Unsolicited Provider Reports Current cover letter provides information on MA Online PMP on-line provider look-ups and alerts Electronic Provider Reports Non-Enrollee Notice Letter to provider informing of alert and how to enroll in Online PMP to obtain specific patient information
MA Online PMP Unsolicited Report Notice From: dcp.dph@state.ma.us To: jsmith@medicaloffice.com Subject: MA Online PMP Drug Utilization Report Massachusetts Department of Public Health Online Prescription Monitoring Program Drug Utilization Report Record ID: 123456789 This is to inform you that, according to an analysis of the records of the Massachusetts Online Prescription Monitoring Program (Online PMP), a patient to whom you have prescribed or dispensed a controlled substance appears to have obtained prescriptions for controlled substances from multiple sources and in potentially harmful quantities.
MA PMP Provider Education *Regulations Promulgated in August 2011 Traditional C.E. Programs for Pharmacists Pharmacy Associations Colleges of Pharmacy Web based program PMP Website Handbook for the Pharmacist ac & Pharmacy acy Software Provider Massachusetts PMP Pharmacy FAQ
MA PMP Provider Education Initiatives Ongoing Toolkits Accompanying each unsolicited report to prescribers and dispensers Screening, Brief Intervention, Referral and Treatment (SBIRT) Further development Working with Addiction Technology Transfer Center (ATTC) Collaboration with medical and pharmacy schools Enhancing SBIRT Screening, Brief Intervention, Referral and Treatment Working with MA Bureau of Substance Abuse Services
MA PMP Provider Education Unsolicited Reports TOOLKIT Unsolicited reports have been sent to prescribers since Jan. 2010 Unsolicited reports to pharmacies (pharmacists) in the near future Access to TOOLKIT on Alliance website Access to TOOLKIT on Alliance website (www.pmpalliance.org)
TOOLKIT cont. Purpose Determine possible aberrant/questionable behavior Opportunities for communication Provide information on prescribing and dispensing of other controlled substances Limitations of data Prescription does not belong to individual of concern Prescriptions could be missing from report Prescriptions attributed to wrong prescriber
TOOLKIT Highlights Overview - Responding to Concerning Activity it PMP report should not be interpreted in isolation from other pertinent patient data such as History of substance abuse Physical signs of current substance abuse Urine screen Consultations with other providers Early refills, lost prescriptions..
TOOLKIT Highlights cont. Overview - Responding to Concerning Activity it SBIRT Screening Non-judgmental discussion with patient It s difficult to confront a patient t on a hunch h or a feeling but having the PMP data report provides an opening for discussion, in a nonjudgmental way. - James Wechsler, MD, PhD Is there a diagnosis? Under-treatment of pain Change in medical condition Is there a reason? Administrative change in care Person did not understand directions
TOOLKIT Highlights cont. Overview - Responding to Concerning Activity it SBIRT Brief Intervention Discuss concerns Interaction with other medications Hinder improvement of medical condition How prescription drug abuse begins Overlapping/ Early refills Negative effects family, employment, legal
TOOLKIT Highlights cont. Overview- Responding to Concerning Activity it Discuss expectations and next steps only one prescriber Increase monitoring dosage counts, urine tests SBIRT RT = Referral and Treatment t Pain specialist or Addiction management
TOOLKIT Highlights cont. Overview - Responding to Concerning Activity it What if provider suspects criminal activity e.g., dr. shopping, forgeries Contact L.E. authorities What if provider concerned about other providers on report? Contact professional boards
MA PMP Provider Education Initiatives Planning Working with Addiction Technology Transfer Center (ATTC) Collaboration with medical and pharmacy schools Enhancing SBIRT Screening, Brief Intervention, Referral and Treatment Working with MA Bureau of Substance Abuse Services
Addictions Technology Transfer Center Raise awareness of evidence-based and promising treatment and recovery service practices, Build skills to prepare the workforce to deliver state-of-the-art addictions treatment and recovery services, Change practice by promoting incorporation of these new skills into everyday use for the purpose of improving ing addictions treatment and recovery outcomes. For more info: ATTCnetwork.org
MA PMP Acknowledgement Portions of this project were supported by grants awarded by the U.S. Bureau of Justice Assistance. Points of view or opinions in this presentation are those of the author and do not represent the official position or policies i of the United States Department of Justice.
Thank you, Adèle Adèle Audet, R.Ph. Assistant Director Drug Control Program 617-983-6721 6721 Adele.Audet@state.ma.us
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