pdmp 4 kreiner small
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PDMP: Prescription Behavior Surveillance System - The Value and Applications of De-identified PDMP Data in Public Health Surveillance - Dr. Peter Kreiner and Mike SmallTRANSCRIPT
PDMP Track: Prescrip/on Behavior Surveillance System: The Value and
Applica/ons of De-‐iden/fied PDMP Data in Public Health Surveillance
Presenters:
Dr. Peter W. Kreiner, PhD, PDMP Principal Inves7gator, Prescrip7on Drug Monitoring Program Center of Excellence, Brandeis University
Mike Small, DOJ Administrator, Law Enforcement Support Program, CA Department of Jus7ce
Moderator: John L. Eadie, Director, Prescrip7on Drug Monitoring Program Center of Excellence, Brandeis University
Disclosures
• Dr. Peter W. Kreiner has disclosed no relevant, real or apparent personal or professional financial rela8onships.
• Mike Small has disclosed no relevant, real or apparent personal or professional financial rela8onships.
Learning Objec/ves
1. Explain the value and applica8ons of de-‐iden8fied PDMP data.
2. List addi8onal resources for op8mum data encryp8on within the PDMP program.
3. State the benefits of coordina8ng interstate data sharing and the barriers that currently exist to limit these agreements.
The Prescrip/on Behavior Surveillance System: Applica/ons of De-‐iden/fied PDMP Data in
Public Health Surveillance
Rx Abuse Summit
April 23, 2014
Peter Kreiner, Ph.D.
PDMP Center of Excellence at Brandeis University
The Prescrip/on Behavior Surveillance System (PBSS)
A longitudinal, mul8-‐state database of de-‐iden8fied PDMP data, to serve as:
1. An early warning surveillance tool 2. An evalua8on tool, in rela8on to state and local
policies and ini8a8ves, such as prescriber educa8onal ini8a8ves
PBSS Con/nued
Began in FY2012 with support from CDC and FDA, administered through BJA Guided by Oversight CommiVee: – Federal partners: CDC, FDA, BJA, SAMHSA – State partners to date: CA, DE, FL, ID, ME, OH
– Addi8onal state partners in process (IN, KY, WA) – Adjunct state partners (MA, OK, TN) – unable to share data but willing to provide PBSS surveillance measures
– No release of data or findings without Oversight CommiVee approval
PBSS Con/nued
De-‐iden8fied data from each par8cipa8ng state – Data use agreements tailored to each state’s laws and requirements
– Beginning with 2010 or 2011, ini8al 2 – 3 years of data – Data updated quarterly (including prior 12 months) – Project-‐specific ID #’s for pa8ents, prescribers, pharmacies
• Maintained for the dura8on of the data – Data housed in secure IT environment at Brandeis University
PBSS Con/nued
Purpose (1): early warning public health surveillance tool – Periodic surveillance report with 40+ pa8ent, prescriber, and pharmacy measures
– Help iden8fy emerging trends, changes in prescrip8on paVerns, indicators of risk associated with new drugs/new drug formula8ons
– Data dic8onary and technical documenta8on – Development of standards in rela8on to data quality (error rates, missing fields) and pa8ent linking (determining which prescrip8on records belong to the same pa8ent)
– Online access for authorized federal researchers – Specialized analyses as agreed upon with each state partner
PBSS Con/nued
Purpose (2): evaluate selected ini8a8ves to influence prescriber behavior – Inventory of state and local prescriber ini8a8ves and
assessment of their evidence base • E.g., state mandates for prescribers to register with and use the PDMP
– Development and valida8on of (popula8on-‐level) measures of (in)appropriate and aberrant prescribing
– Evalua8on of selected REMS trainings
Surveillance Data: Selected Examples • Opioid prescrip8on rates by age group, comparison
across states • Number of Schedule II – V opioids per 1,000 state residents
(in each age group)
• Mul8ple provider episode rates by age group, comparison across states • Number of pa8ents with prescrip8ons from 5 or more
prescribers and 5 or more pharmacies in a 3-‐month period, per 100,000 state residents
• Mul8ple provider episode rates by quarter, 2010 – 2013 (Ohio)
• Mul8ple provider episode rates by community: MassachuseVs
Further Data Examples
• Propor8on of total prescrip8ons accounted for by prescriber deciles: prescriber 10% groupings based on prescrip8on volume
• Average daily opioid dosage (morphine milligram equivalents)
• Average daily opioid dosage by prescriber decile (based on volume of opioid prescrip8ons
Further Data Applica8ons
• Community profiles based on PDMP measures • Inform local preven8on and treatment needs assessment • Help evaluate local interven8ons/track community
progress in addressing prescrip8on drug issues
• Mass. PMP/Brandeis are developing community profiles for: • BJA Data Sharing Pilot grantee (Norfolk County District
AVorney’s Office)
• CSAP/Bureau of Substance Abuse Services grantees addressing non-‐medical use of prescrip8on drugs
• BSAS block grant-‐funded grantees addressing opioid abuse
Further Data Applica8ons, Con8nued
• Versions of PBSS surveillance reports/measures for PDMP cons8tuencies: • Governor, legislators, other state agencies, consumer
groups, etc.
• Epidemiological analyses tailed to state needs • Examina8on of pa8ent, prescriber, and dispenser behavior
over 8me: what earlier paVerns are associated with (eventual) risk indica8ons?
• E.g., paVerns of risk indicators sugges8ve of collec8ve ac8vity, drug rings
• More detailed examina8on of prescribing paVerns for children or elderly persons
A Concluding Note
• Increasing use of PDMP data highlights a need for data quality and data consistency • States vary in measures to ensure and improve data quality
• States vary in procedures to determine which prescrip8on records belong to the same pa8ent
• An important part of PBSS is the development of methods to assess data quality and to assess the adequacy of prescrip8on linking procedures
• And to assist PBSS states in implemen8ng best prac8ces for data quality and linking procedures, and processes for ongoing quality improvement
Contact Informa/on
Peter Kreiner, Ph.D. Principal Inves8gator
PDMP Center of Excellence Brandeis University
781-‐736-‐3945 [email protected]
www.pdmpexcellence.org