Prescription Drug Monitoring Programs - PDMP Center of Excellence

Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 37One of the most significant challenges facing PDMPs has been the slow increase in enrollment in and useof PDMPs by prescribers and pharmacists. Rates of enrollment among prescribers are well below 50percent in most states. 4 Best practices, therefore, need to be identified for how PDMPs can mostefficiently increase enrollment among user groups, including producing enrollments of, for example, atleast 50 percent of those who wrote 10 or more controlled substance prescriptions in the past year, orof prescribers of at least 50 percent of prescriptions written.To inform best practices in this domain, appropriate rates of enrollment need to be studied, taking intoaccount that many providers prescribe infrequently and that a relatively small proportion of prescribersare responsible for issuing most controlled substance prescriptions. Data from the Massachusetts PDMPindicate that just 30 percent of all those who prescribed an opioid at least once in 2011 wereresponsible for 88 percent of all opioid prescriptions in 2011 (MADPH Advisory Council Presentation,2012). This suggests that to maximize the effectiveness of PDMPs, recruitment strategies couldprofitably be focused on the most frequent prescribers of those controlled substances implicated inabuse and diversion (see immediately below).1. Proactively identify and conduct outreach to potential high-­‐impact usersRationale and evidence for effectiveness: Certain categories of potential PDMP users are a high priorityfor enrollment given the impact their use of PDMP data would likely have in improving prescribing anddispensing, and in reducing diversion and abuse of prescription drugs. Primary among these are the mostfrequent prescribers of controlled substances, such as the top 10 percent in terms of prescriptions peryear (Paulozzi, 2011), as well as those prescribers with relatively high proportions of suspected doctorshoppers in their practices. Such prescribers are readily identifiable using PDMP data and can beencouraged to enroll in and use the PDMP via letters and alerts, either electronically or by mail. In 2010,Utah’s PDMP analyzed its data to identify top prescribers, then contacted them electronically, resultingin a rapid rise in enrollment among this group. Massachusetts is currently conducting an initiative toidentify prescribers with relatively high proportions of doctor shoppers in their practices; theseprescribers are receiving letters suggesting they join and use the Massachusetts PDMP. Theseprescribers’ enrollment in and utilization of the PDMP will be monitored, along with any changes thatmay occur in the proportion of possible doctor shoppers in their practices.Current adoption status: Contact with other PDMPs is warranted to ascertain which are engaged insimilar efforts and assess outcomes, including on enrollment, utilization, prescribing, doctor shoppingrates, and proportions of doctor shoppers among identified frequent prescribers. Outreach to frequentprescribers for enrollment in the PDMP will need to be coordinated with licensure boards andinvestigative agencies in case any of the identified practitioners happen to be subjects of disciplinaryaction or investigations.4According to data during the first half of 2010 from Harold Rogers PDMP Grant Program, of 12 PDMPs withoperational online Web portals for prescribers to request prescription history reports, 11 reported 9 to 39 percentof prescribers who issued controlled substances prescriptions were registered. Only one state (Hawaii) reported100 percent registration.