State-based Prescription Drug Monitoring Programs Might Help Increase Opioid Prescribing Safety among Veterans Using VA and Non-VA Healthcare
Within the VA healthcare system, opioid use has paralleled national trends, as the number of Veterans who received an opioid prescription increased from 350,000 in 2003 to nearly 900,000 in 2013. Thus, VA has taken a multi-faceted approach to combat opioid misuse and abuse. Launched in 2012, the VA Opioid Safety Initiative has sought to ensure safe opioid use through patient and prescriber education, close patient monitoring, and by increasing the availability of alternative pain therapies. However, while opioids prescribed within VA have decreased by 25% from their peak in 2013, Veterans continue to receive opioids from non-VA providers. State-based Prescription Drug Monitoring Programs (PDMPs) track dispensed controlled substances and are a tool to identify Veterans' receipt of opioids from non-VA prescribers. This study evaluated VA physicians' perspectives and experiences regarding the use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers. From February through August 2016, investigators conducted telephone interviews with 42 VA primary care physicians (15 from Illinois, 15 from Pennsylvania, and 12 from Massachusetts) that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use.
- VA primary care physicians broadly embraced PDMPs as a tool to monitor Veterans' receipt of opioids from non-VA sources despite identifying multiple barriers to optimal use. They also identified several key best practices currently used within VA and made suggestions for future improvements that may enhance efforts to ensure safe opioid prescribing.
- Key barriers included incomplete or unavailable prescribing data, while key facilitators included linking PDMPs with VA's electronic health record, using templated notes to document PDMP use, and delegating routine PDMP queries to ancillary staff (i.e., nurses or clinical pharmacists).
- PDMP use also challenged physicians' underlying biases regarding opioid misuse, causing them to re-evaluate their own biases regarding who they suspected could be misusing opioids.
- Applying improvements identified in this study may enable VA to serve as a national model for those seeking to enhance PDMP use, thereby improving opioid prescribing safety.
- This study focused largely on structural barriers and facilitators regarding PDMP use, rather than whether PDMP use directly influenced physicians' clinical decision-making.
- Findings represent the perspectives of primary care physicians. Other types of prescribers, such as specialty physicians, dentists, and advanced practice providers, may possess different insights.
This study was partly funded by HSR&D (IIR 14-297). Drs. Radomski and Gellad, and Ms. Bixler are part of HSR&D's Center for Health Equity Research and Promotion (CHERP). Dr. Zickmund is Associate Director of HSR&D's Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0).
Radomski T, Bixler F, Zickmund S, et al., and Gellad W. Physicians’ Perspectives Regarding Prescription Drug Monitoring Program Use within the Department of Veterans Affairs: A Multi-State Qualitative Study. Journal of General Internal Medicine. March 8, 2018; Epub ahead of print.