The overarching goal of this research is to help providers improve the care of complex patients requesting controlled prescription medication. Specifically, the study examines the potential of a statewide prescription monitoring program (PMP) to help providers assess whether a given patient has a legitimate pain need, an addiction, or intent to divert or misuse controlled substances. Over the past decade, increasing availability of prescription opioids has led to a substantial increase in opioid misuse, poisonings, and related deaths. In response, 38 states have implemented PMPs in an attempt to combat this rising epidemic, but research on PMP effectiveness remains limited. Few studies have examined the processes by which providers might use PMPs to decide whether to prescribe or to refer for more appropriate care. Most states'PMPs focus on law enforcement, with the aim of identifying "doctor shoppers" and regulating inappropriate or illegal prescribing. However, Oregon plans to implement a PMP in 2010 with a public health focus, offering a unique opportunity to study how providers integrate PMPs into clinical care and to inform the development of clinical guidelines for PMP use. This study has three specific aims. First, we aim to compare the specialty and demographic characteristics of providers who use or do not use the PMP, and to identify barriers to using PMP data. These findings will assist state PMPs to increase adoption rates among providers. Second, we aim to understand how and when providers use PMP data to intervene with patients and make clinical decisions about prescribing controlled medications or referring to more appropriate treatment. These findings will inform the development of national clinical guidelines by offering recommendations regarding use of PMPs to improve quality of care. Third, we will compare patient outcomes among PMP users and non-users, including hospitalizations, emergency department use, and evidence of diversion. These data will begin to explore whether PMPs are effective at reducing diversion and misuse of controlled prescription medications, an assumption underlying many PMPs, but which, to date, remains largely untested. The research methods to accomplish these aims include an electronic survey of providers, qualitative interviews with PMP users, mapping of clinical decision-making processes with "super users," and quantitative analysis of claims and pharmacy data on patient outcomes.

Public Health Relevance

Prescription monitoring programs (PMPs) exist in 38 states to combat the rising national epidemic of prescription drug abuse and related overdoses and deaths, yet there is scant research exploring their clinical utility and effectiveness. Little is known regarding how PMP information can be used by providers to differentiate between patients with legitimate clinical needs (e.g., pain control) and those that may be abusing or misusing medications, and to make appropriate treatment decisions. Findings from this study will inform PMP administrators, policy makers, clinical experts, and practitioners nationwide regarding the development of guidelines for incorporating PMP data into clinical practice, thereby improving population outcomes while maintaining prescribing practices for patients with legitimate needs.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA031208-03S1
Application #
8837814
Study Section
Program Officer
Crump, Aria
Project Start
2014-02-01
Project End
2017-01-31
Budget Start
2014-02-01
Budget End
2015-01-31
Support Year
3
Fiscal Year
2014
Total Cost
$49,999
Indirect Cost
$17,532
Name
Oregon Health and Science University
Department
Family Medicine
Type
Schools of Medicine
DUNS #
096997515
City
Portland
State
OR
Country
United States
Zip Code
97239
Hildebran, Christi; Cohen, Deborah J; Irvine, Jessica M et al. (2014) How clinicians use prescription drug monitoring programs: a qualitative inquiry. Pain Med 15:1179-86
Irvine, Jessica M; Hallvik, Sara E; Hildebran, Christi et al. (2014) Who uses a prescription drug monitoring program and how? Insights from a statewide survey of Oregon clinicians. J Pain 15:747-55
Deyo, Richard A; Irvine, Jessica M; Hallvik, Sara E et al. (2014) Leading a Horse to Water: Facilitating Registration and Use of a Prescription Drug Monitoring Program. Clin J Pain :
Deyo, Richard A; Irvine, Jessica M; Millet, Lisa M et al. (2013) Measures such as interstate cooperation would improve the efficacy of programs to track controlled drug prescriptions. Health Aff (Millwood) 32:603-13