4. Unsolicited Reports
In some states, the PDMP data is evaluated and analyzed to spot potential problem behavior on the part of patients, prescribers, or both. Those patients can then be flagged so that their physicians will receive unsolicited alerts or reports.
This takes the onus of evaluating the prescription information off the doctor, which saves time and potentially makes it easier to spot a developing dependency problem earlier. According to Pew, roughly two-thirds of state programs provide these types of notifications.
“The reports identify problems up front and allow for earlier interventions,” Reilly says. “Each state sets it own thresholds in terms of identifying patients that may be at risk.”
Taking the next step
PDMPs have made it easier to identify patients with emerging substance use problems, but there has been no uniform approach to helping those patients once doctors have that information. Meanwhile, addiction treatment is underfunded and difficult to access.
“There is still a gap between treatment need and treatment capacity,” Reilly says. “That gap still has to be addressed.”
It’s not always clear how physicians are responding. They might be “firing” patients, or referring them to treatment. Some states have attempted to measure physician responses, but Green says there is a scarcity of that type of data, too.
"Just because you gave a patient a referral to treatment doesn’t mean they are going,” she says.
A small focus group study led by the Oregon Health and Science University in 2014 found that physicians take widely varying approaches to discussing PDMP findings with patients (from opening up a dialogue, to quietly getting them to leave the building). Most reported receiving no training beyond how to access the PDMP.
Addiction treatment professionals have a role to play, but are somewhat limited in terms of what they can do because only a few states allow non-prescribing clinicians access to PDMP data. While methadone and buprenorphine prescribers typically don’t check PDMPs for opioid prescriptions, advocates believe they should. And in most cases, such prescribers are not adding the methadone or buprenorphine dispensing to the PDMP for other providers to see.
“There are efforts to better link PDMPs and the treatment community, but we have to be careful because there are patient confidentiality concerns here,” Green says.
Regulations in 42 CFR Part 2 typically prevent broad access to patient information among providers, which would include PDMPs.
“There has been some reluctance to incorporate those types of queries because of confidentiality concerns,” Kreiner says. “But there are some potentially harmful effects when it comes to patients having prescriptions that providers don’t know about.”
Both SAMHSA and CDC have been awarding state grants for improvements in prevention and treatment services.
“Some grantees have proposed doing projects that would detail how physicians can better deal with patient referrals, and how to improve information systems when it comes to tracking those patients,” Kreiner says. “Those are still in the early stages.”
The resource shortage is still the biggest obstacle.
“Only 10% of people who need treatment are getting it,” Reilly says. “More clinician engagement can go a long way in addressing that gap. The PDMP can be a tool to have discussions with those patients so that treatment can be more successful.”
Brian Albright is a freelance writer based in Ohio.
PDMP TTAC Best Practice Checklist: http://www.pdmpassist.org/pdf/2016_Best_Practice_Checklist_Report_20170228.pdf
PDMP TTAC: http://www.pdmpassist.org
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