The APRN Experience Using Prescription Drug Monitoring Programs

Transcription

1 NCSBN APRN Roundtable 2015 April 15, 2015 The APRN Experience Using Prescription Drug Monitoring Programs Stacey Pfenning DNP APRN FNP ND Board of Nursing Associate Director Bismarck, ND

2 Practice Story My Practice and the PDMP Before PDMP After PDMP

3 Objectives Prescription Drug Monitoring Program (PDMP) in APRN practice Overview Registration & utilization Strengths/benefits Weaknesses/barriers Improving PDMP use in APRN practice Registration process Education & follow up Legislation impacting APRN use of PDMP in practice

4 PDMP in APRN Practice Prescription Drug Abuse Epidemic 2012: 16,007 deaths involving opioids : drug-poisoning deaths due to opioids more than tripled 1.4/100,000 in 1999 & 5.1/100,000 in 2012 Greatest increases through 2006 (approx. 18%/year); 5% decline : 2.5 million ED visits for drug misuse/ abuse-50.5% involving nonmedical use of pharmaceuticals (DAWN Report, 2011; Warner, Hedegaard, & Chen, 2014)

5 PDMP in APRN Practice PDMP Synopsis Online database of controlled substances (II-V) Data collected from pharmacies once prescription is dispensed Available to authorized users (many electronically) Secure & HIPPA compliant As of December 2014: Authorized PDMP: 49 states & 1 territory Operating PDMP: 47 states (NAMSDL, 2015)

6 PDMP in APRN Practice PDMP Purpose Tool aimed to improve clinical decisionmaking in patient therapy Allow prescribers to identify and inhibit misuse, diversion, or excessive prescribing of controlled substances Curb prescription drug abuse epidemic Improve patient safety and public health (NAMSDL, 2015)

7 PDMP in APRN Practice Registration 21 states have mandatory registration AL, AZ, CA, CO, CT, DE, GA, ID, KY, ME, MA, MS, NH, NM, OH, RI, TN, UT, VT, VA (6/2015), WV 13 states with mandatory training: KY, LA, MA, MT, NV, NJ, NM, OH, PA, SC, UT, VT, WV Registration process Tends to be a barrier to use Online registration Required supporting documents vary by state (notarization) (NAMSDL, 2015)

8 PDMP in APRN Practice Utilization 24 states with mandatory access: AZ, CO, DE, GA, IN, KY, LA, MA, MN, MS, NV, NM, NY, NC, ND, OH, OK, PA (7/2015), RI, TN, VT, VA, WA, WV 16 states, by law, do not require prescribers/dispensers to access PDMP 11 states & 1 territory require prescribers/dispensers to notify consumers of PDMP access (NAMSDL, 2015)

9 PDMP in APRN Practice Evidence Hildebran et al. (2014)-qualitative study How do clinicians incorporate PDMP into workflow and decision-making? What barriers exist? How is this information shared with patients? Findings 35 clinicians from 9 states interviewed Variations in access & use among clinicians Concerns: decreased patient satisfaction

10 PDMP in APRN Practice Evidence Green et al. (2012)-quantitative study How are the reports used in practice? Examine PDMP use in suspected diversion Findings 1, 385 prescribers from 2 states responded (29.6% response rate among PDMP users) >50% use electronic PDMP >monthly Uses for PDMP in practice included: Screening for drug abuse, counseling on risks of opioids, Detecting doctor shopping Tool for discussing patient health status

11 PDMP in APRN Practice Evidence Rutkow et al. (2015)-quantitative What are attitudes toward PDMP? What is the awareness and use of PDMP? Findings 420 responded to survey 72% aware of PDMP; 53% reported use of PDMP but not routinely Barriers: time-consuming, lack of intuitive format of data

12 PDMP in APRN Practice Number of Prescriptions Dispensed Per Year to ND patients and in the state of ND NDPDMP, 2015

13 PDMP in APRN Practice Number of Active Accounts NDPDMP, 2015

14 PDMP in APRN Practice Utilization in ND Utilization Rates of the Prescribers who wrote a controlled substance prescription which was dispensed in ND or to ND residents. 30.0% 25.0% 20.0% 18.1% 20.2% 20.6% 21.1% 27.0% 25.9% 25.3% 15.0% 12.8% 12.7% 12.5% 12.6% 11.6% 12.2% 12.0% 11.8% 11.4% 12.9% 10.0% 7.7% 5.0% 0.0% NDPDMP, 2015

15 PDMP in APRN Practice ND Utilization Rates 2014 Non-physician prescribers Physician prescriber NDPDMP, 2015

16 PDMP in APRN Practice Strengths/benefits Improved clinical decision-making Decrease in misuse/abuse/overdoses Overall enhanced patient & public safety Weaknesses/barriers Enrollment process Accuracy of PDMP Depends on what patient reports, prescriber writes, and pharmacy enters (name, DOB) 22 states require id before dispensing

17 ND PDMP Survey Overview Would you recommend PDMP? What are weaknesses? What are benefits? 446 Respondents Net Promoter Score of 53 Less than 0=poor results, program not liked 0-50=good, program liked >50=excellent, program very well liked Approx. 102 described weakness Approx. 378 described positive NDPDMP, 2015

18 ND PDMP Survey Overview Themes What are negatives Cumbersome registration Difficult program (access and use) Takes too much time to access and obtain results Patient data required too specific Question accuracy, seems incomplete Need more education to use NDPDMP, 2015

19 ND PDMP Survey Overview What are positives Accessible anytime, immediate Provides important data, allows for a large picture of patient prescriptions Prevents from contributing to additive behaviors Easy to access User friendly Multiple states feature is useful Great resource for practice More information to make more informed decisions NDPDMP, 2015

20 Improving PDMP Use in APRN Practice Registration process Measures to enhance ease of registration Attending state based conferences ND PDMP & Board of Pharmacy teamed attending APRN conferences Sign up on the spot Provide education on PDMP Collaborating with Boards of Nursing to facilitate ease of registration NDBON representative on PDMP Advisory council Seeking ways to eliminate notary requirement

21 Improving PDMP Use in APRN Practice Education Prescriber education on PDMP registration and utilization in practice Consider educational opportunities at APRN conferences through presentations and PDMP booths Follow-up Letters sent to prescribers not registered Consideration of prescriber legal mandates NDPDMP, 2015; Rutkow et al.2015

22 Legislation Impacting APRN Use of PDMP Legislation Collaborations: Board of Pharmacy, Attorney General, Board of Medical Examiners, Pharmacy Association, Department of Health, Law Enforcement Developed Bill allowing Licensing Boards to write own PDMP rules Mandates related to registration and access Rules Registration rules Utilization rules

23 Conclusion As an APRN, the PDMP can provide accurate and timely information pertaining to prescribing controlled substances for our patients. This is a tool to promote safe prescribing for these medications. There is still work to be done to promote registration and use of the PDMP and education will go a long way in promoting this program

24 References Delcher, C., Wagenaar, A., Goldberger, B., Cook, R., & Maldonado-Molina, M. (2015). Abrupt decline in oxycodone-caused mortality after implementation of Florida s prescription drug monitoring program. Drug and Alcohol Dependency. doi: /j.drugalcdep Forster, A. J., Erlanger, T. E., Jennings, A., Auger, C., Buckeridge, D., van Walraven, C., & Tamblyn, R. (2015). Effectiveness of a computerized drug-monitoring program to detect and prevent adverse drug events and medication non-adherence in outpatient ambulatory care: study protocol of a randomized controlled trial. Trials, 16(2). doi: / Gindi, R., Cohen, R., & Kirzinger, W. (2012). Emergency room use among adults aged 18-64: Early release of estimates from National Health Interview Survey, January-June National Center for Health Statistics. Available: Green, T. C., Mann, M. R., Bowman, S. E., Zaller, N., Soto, X., Gadea, J., &... Friedmann, P. D. (2012). How Does Use of a Prescription Monitoring Program Change Medical Practice?. Pain Medicine, 13(10), Griggs, C. A., Weiner, S. G., & Feldman, J. A. (2015). Prescription Drug Monitoring Programs: Examining Limitations and Future Approaches. Western Journal of Emergency Medicine, 16(1), doi: /westjem Haffajee, R. L., Jena, A. B., & Weiner, S. G. (2015). Mandatory use of prescription drug monitoring programs. JAMA: Journal Of The American Medical Association, 313(9), doi: / jama

25 References Heagerty, K. E. (2013). Prescription Monitoring Programs: To Use or Not to Use. Innovations In Clinical Neuroscience, 10(11/12), Hildebran, C., Cohen, D. J., Irvine, J. M., Foley, C., O'Kane, N., Beran, T., & Deyo, R. A. (2014). How Clinicians Use Prescription Drug Monitoring Programs: A Qualitative Inquiry. Pain Medicine, 15(7), Irvine, J., Hallvik, S., Hildebran, C., Marino, M., Beran, T., & Devo, R. (2014). Who uses a prescription drug monitoring program and how? Insights from a statewide survey of Oregon clinicians. The Journal of Pain, 15(7), doi: /j.jpain National Alliance for Model State Drug Laws (NAMSDL). (2015). Prescription Monitoring Programs- Stated Law and Policy Profiles. Available at ND Prescription Drug Monitoring Program (2015). Statistics on accounts and utilization in ND. NDPDMP Advisory Council meetings Permission to use per PDMP Administrator. Rutkow, L., Turner, L., Lucas, E., Hwang, C., & Alexander, G. C. (2015). Most Primary Care Physicians Are Aware Of Prescription Drug Monitoring Programs, But Many Find The Data Difficult To Access. Health Affairs, 34(3), doi: /hlthaff Smith, R., Kilaru, A., Perrone, J., Paciotti, B., Barg, F., Gadsden, S., & Meisel, Z. (2015). How, why, and for whom do emergency medicine providers use prescription drug monitoring programs? Pain Medicine. doi: /pme

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