Why prescribers don’t regularly check the PDMP
To date, 49 states and the District of Columbia operate Prescription Drug Monitoring Programs (PDMPs), and the 50th state (Missouri) passed a law to establish one soon. These state-run databases were created to prevent and uncover prescription drug abuse, particularly cases of “doctor shopping” and “pharmacy shopping.” Although PDMPs have now been adopted across the entire U.S., most prescribers still aren’t using them.
In an effort to promote PDMP use, nearly 25 states have begun to require or recommend that doctors register for accounts to use them. National studies have shown that 72 percent of doctors are aware of their state’s PDMP program, and 53 percent report that they have used it.
In Colorado, over 95 percent of health care professionals had signed up for the state PDMP by mid-2015 – a huge increase from 31 percent a little over a year prior. This resulted from a “mandatory registration” law requiring all prescribers and pharmacists to register an account with the PDMP. But despite these impressive sign up numbers, for every 100 controlled substance prescriptions dispensed in Colorado in mid-2015, only 15 physician queries had been run against the PDMP.
So, if PDMP databases are a key line of defense (with research backing their utility) for doctors to help reduce opioid abuse, why aren’t they using them more often? The answer is complicated.
First, most states don’t go as far as requiring prescribers to use the database (only to register for an account, so that they could use it).
Second, doctors face tremendous pressure to see as many patients as possible, as quickly as possible. Checking the PDMP is time consuming, averaging about 5-6 minutes per patient per visit just to pull up a PDMP report. Then, the prescriber must wade through the text-based report, line by line, and interpret it. That just ate up 10 minutes of a typical 15-minute clinic visit. In fact, the same national studies I mentioned earlier showed that when it comes to using the data from the PDMP, 58 percent of physicians report that the information is too time-consuming to retrieve, and 28 percent indicate that the information is not in an easy-to-use format.
Third, doctors and patients have concerns about patient privacy, and some physician groups have challenged this type of data collection. The Supreme Court ultimately ruled that the collection and use of prescriber data is legal and constitutional, due to the important public health objectives involved, as long as security measures are adequate to protect the data.
And fourth, existing PDMP systems are rather clunky (pardon the technical lingo), requiring duplicate data entry, separate system logins, clumsy interfaces and many clicks to obtain desired results. Clinician frustration and low rates of PDMP use are understandable given the circumstances.
We at RxAssurance believe that automated PDMP checks, performed for physicians by our OpiSafe platform in a matter seconds while they spend their time diagnosing pain and developing treatment plans with their patients, and presentation of easily viewed graphical results (indicative of patterns of prior controlled substance use, if any, by the patient) will help make clinical encounters more efficient and effective, for doctor and patient alike.
Robert J. Valuck, PhD, RPh, FNAP, is co-founder and chief strategy officer at RxAssurance.