Designing Effective Prescription Monitoring Programs

Chances are, not that much, according to speakers at the APS’ 29^th Annual Scientific Meeting’s symposium on state Prescription Monitoring Programs, and it’s not necessarily your fault.

While prescription monitoring programs have been in place for many years in over 30 states, the number of physicians routinely accessing these databases is small, and that’s partly due to the fact that these tools are not designed in a way that allows them to realize their full potential.

The objective of this symposium was to discuss the current status of State Prescription Monitoring Programs, examine published empirical data on the effects of prescription monitoring programs, and evaluate recent research.

Prescription monitoring programs generally store data on how often patients receive prescription drugs, how many pharmacies they visit, how many physicians they visit in a short span of time, rates of physician prescriptions, and similar items.

Aaron Gilson, PhD, director of the U.S. Program at the Pain & Policy Studies Group/WHO Collaborating Center for Policy and Communications in Cancer Care, discussed the lack of empirical evidence on PMPs’ efficacy in decreasing prescription medicine diversion and the need for research during his presentation.

Gilson noted that PMPs tend to focus exclusively on the prescribing of schedule II drugs, are run by a state health agency, utilize a form of electronic data transfer system, and usually contains a stated or worded intent not to interfere with the proper prescribing of medications.

He stressed the need for “information exchange, assessment of utility of advisory committees, and enhancements to aid real-time capability,” in designing efficient and effective PMPs.

By providing access of the databases to practitioners, Gilson noted that physicians will be better guided to make clinical decisions.

Robert Twillman, PhD, psychiatry and behavioral sciences professor at the University of Kansas School of Medicine, presented information on an analysis of 11 years worth of data taken from Massachusetts PMP (1996-2006). The program only covers schedule II medications and access to the databse is limited to law enforcement. Data demonstrated that the number of class II prescriptions increased by 142% within that time frame and the number of doses prescriped increased by almost 300%.

Twillman said enhancing these programs can lead to determining abherrant patterns of medicatiin use, to spurring in-depth assessments, and to deterring patients from performing misuse activities.

Dr. Scott Fishman, presented data on California’s PMP, focusing on triplicates, a three-part prescription program that was the standard for many years. Fishman noted that triplicates were heavily unpopular with physicians, which produced tension between healthcare and government.

The program in California had actually created an unforeseen problem, he said. Since the triplicate program made the process of prescribing schedule II drugs a bit more complicated, data demonstrated that the number of individuals using schedule III drugs increased “astronomically.”

While the previous speakers emphasized the need for physicians to take notice of PMPs and get involved, Dr. June L. Dahl, professor of pharmacology at the University of Wisconsin School of Medicine and Public Health, said the call to action should have been made a little sooner.

“I believe that maybe it’s too late,” Dahl said. “that in fact If we had really effective and appropriate prescription monitoring programs in operation than we wouldn’t have to be thinking of REMS and other federal mandates that have a great potential to adversely affect the quality of care.”

Among her ideas for a competent PMP model, would be to create a program that avoids violations of patient privacy, that does not interfere with legitimate medical practice, that is comprehensive in data collection, and that is housed in healthcare rather than a law enforcement agency.

“A PMP should recognize the principle of balance,” she said.

How much do you know about Prescription Monitoring Programs in your state?