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TRANSCRIPT
When PrescribersUse PDMP Data
Presenters:• Sara Hallvik, MPH, Healthcare Analyst Manager, Acumentra Health• Christi Hildebran, LMSW, CADC III, Research Manager, Acumentra Health • Cynthia Reilly, Director, Prescription Drug Abuse Project, The Pew Charitable
Trusts• John L. Eadie, Coordinator, Public Health and Prescription Drug Monitoring
Program Project, National Emerging Threat Initiative, National HIDTA Assistance Center
PDMP Track
Moderator: Anne L. Burns, RPh, Vice President, Professional Affairs, American Pharmacists Association, and Member, Rx and Heroin Summit National Advisory Board
Disclosures
John L. Eadie; Sara Hallvik, MPH; Christi Hildebran, LMSW, CADC III; Cynthia Reilly; and Anne L. Burns, RPh, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.
Disclosures
• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
• The following planners/managers have the following to disclose:– John J. Dreyzehner, MD, MPH, FACOEM – Ownership interest:
Starfish Health (spouse)– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
Learning Objectives
1. Explain the benefits when prescribers use PDMP data.
2. Outline evidence-based practices that increase prescriber utilization of PDMPs.
3. Compare opioid prescribing patterns before and after provider registration with the Oregon PDMP.
4. Provide accurate and appropriate counsel as part of the treatment team.
Christi Hildebran, LMSW, CADC IIISara Hallvik, MPH
Acumentra Health Portland, Oregon
When Prescribers Use PDMP Data
Opioid Prescribing Before and After PDMP Registration
Disclosure Statement
Christi Hildebran, LMSW, CADC III, and Sara Hallvik, MPH,
have disclosed no relevant, real or apparent personal or professional financial relationships
with proprietary entities that produce health care goods and services.
Learning Objectives
1. Explain the benefits when prescribers use PDMP data.
2. Outline evidence-based practices that increase prescriber utilization of PDMPs.
3. Compare opioid prescribing patterns before and after provider registration with the Oregon PDMP
4. Provide accurate and appropriate counsel as part of the treatment team.
National Institutes of HealthFunded Study
“Use of Prescription Monitoring Programs to Improve Patient Care and Outcomes”
Supported by the National Institutes of Health, National Institute for Drug Abuse through Grant #1 R01 DA031208-01A1, and by the National Center for Research Resources and the
National Center for Advancing Translational Sciences, through grant UL1RR024140.
Background
• PDMPs increasingly used for public health: reduce drug abuse, improve patient safety
• Many clinicians who prescribe controlled drugs do not use PDMPs
• Little is known about the impact of PDMP use on prescribing practices and patient outcomes
Oregon PDMP History• Oregon PDMP became operational in
September 2011.
• Oregon PDMP is paid for by an annual fee of $25 that is included in board licensee fees of prescribers and pharmacists.
• NIH grant to study Oregon’s PDMP awarded in February 2012.
Oregon PDMP Profile• Optional registration and use• User must pull query information from website
(no push notifications or unsolicited reports)• Providers’ experience of using PDMP is mixed
– time constraints in accessing the system– cannot delegate access– system difficult to access and navigate– frequent password changes– provides objective evidence of patient’s prescription
history
PDMP Registration by Type
0
1000
2000
3000
4000
5000
6000
Delegates
MD / DO
NP / PADDS/DMD
RPh
Cumulative system accounts by quarter and disciplineN
umbe
r of S
yste
m A
ccou
nts
State Policy Changes During Study Time Period
• Beginning in 2012, there were new financial arrangements (CCOs), guidelines and authorizations required by Medicaid.
• Regional Pain Collaborative developed across the state.
• Delegated access in effect as of January 2014.• System interface upgraded in 2014.
Study AimsUnderstand the prescribing differences between registered prescribers and non-registered prescribers and how their patient outcomes differ. Does use of the PDMP improve patient outcomes?
HypothesisProviders who register for PDMP will reduce prescribing and prescribe more safely after registering to use.
Definitions• Registered User: Prescriber who registers to use the PDMP. • Non-Registered User: Prescriber who does not register to use the
PDMP.• Query: Prescriber (or delegate) runs a query in the PDMP to see a
patient’s prescriptions.• Death*: Identified in vital records (death certificates) with underlying
cause AND contributing cause ICD-10 codes indicating poisoning by opioids, regardless of intent.
• Overdose hospitalization*: Identified in hospital discharge registry data with– Poisoning ICD-9 code, OR– Adverse effect of opioid ICD-9 code on the same day as a diagnosis or intent
code (e-code) suggestive of overdose.
*Including heroin
Methods• Improved patient linkage within PDMP
• Created clean PDMP dataset, Oct ‘11‒Oct ‘14– Removed invalid prescriptions and prescriptions
from non-Oregon prescribers
– Augmented classification of drugs; strength and conversion factor information to calculate MME
• Linked PDMP with statewide hospital discharge registry and vital records
Methods• Defined a set of measures to describe provider
prescribing practices• Calculated measures in the 12 months before and 12
months after date of registration, among providers who registered to use the PDMP between October 2012 and September 2013
• Used propensity score methods to match each registered provider (n=1,131) with a non-registered provider of similar “pre” prescribing profile (n=1,131)
Provider cohorts (registrants and non-registrants) were very well matched
Prescribing variable used for matching Mean difference*Number of patients with an opioid prescription .030Average pills per opioid prescription .050Average dose (MME) per prescription .028Average dose (MME) per patient .027Percent of patients with high dose (MME) .016Number of benzodiazepine prescriptions .043
*Mean difference is the standardized distance between the “pre” value of each pair. Values <0.1 indicate negligible differences.
Methods
Then we examined: 1. statewide trends in prescribing over time2. pre-post change in prescribing between matched
registered and non-registered provider cohorts3. pre-post change in prescribing considering the
number of queries made in PDMP system
Q4 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
80010001200140016001800200022002400
1690 1620 1674 1660 1668 15571498
Number of opioid units (pills) dispensed per 100 population
Volume of opioids in the state decreased over time
Q4 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
0.71 0.70 0.71 0.70 0.690.64
0.61
Number of patients with a quarterized MME greater than or equal to 100MME per 100 population
Chronic high dose of opioids decreased over time
Q4 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
0.00
0.05
0.10
0.15
0.20
0.11 0.11 0.10 0.10 0.09 0.09 0.09
Number of inappropriate prescriptions* per 100 popu-lation
Inappropriate prescribing decreased over time*same medication within 7 days from a different prescriber
Q4 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
0.40
0.50
0.60
0.70
0.80
0.90
1.00
1.10
0.800.76 0.77 0.76 0.73
0.670.64
Number of methadone Rx per 100 population
Volume of methadone decreased over time
Q4 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
11.0 11.09.3
10.3 10.2 9.8 10.1
0.9 1.5 1.6 1.7 1.21.7 1.5
Statewide opioid-related overdose deaths and hospitalizations per 1,000 population
Overdose Hospitalizations Overdose Deaths
Overdose hospitalizations and deaths remained steady over time
Time Trend Results• General downward trend in per capita
prescribing• Stagnant per capita death and hospitalization
overdose rates
Hypothesis• Providers who register for PDMP will reduce
prescribing and prescribe more safely after registering.
Pre–Post Change in Prescribing PatternsPrescribing pattern Registered Non-registered p-value
n 1,131 1,131 Change Change Number of opioid prescriptions 91.5 -8.6 <.0001Number of patients with an opioid prescription 33.2 -2.1 <.0001Dose (MME) per patient 2.14 -1.71 .0023Pills per opioid prescription 4.6 -2.6 <.0001Number of methadone prescriptions 4.1 -0.2 .0006Number of benzodiazepine prescriptions 24.4 -4.1 <.0001Percent of opioid prescriptions with a sedative-hypnotic or carisoprodol prescription within 30 days .018 .005 .0005Number of inappropriate prescriptions .054 -.005 .0355
• Registered providers increased prescribing after registration• Non-registered provider pairs decreased prescribing in the
same time period
Pre-Post Change in Prescribing Patterns Among Registered Prescribers, According to Query Frequency
Prescribing patternTop quartile of
PDMP usersBottom quartile of PDMP users p-value
n 282 342 Change Change Number of opioid prescriptions 144.92 -6.34 <.0001Number of patients with an opioid prescription 61.01 -1.11 <.0001Dose (MME) per patient 3.71 -2.29 <.0001Pills per opioid prescription 11.50 -1.86 <.0001Number of methadone prescriptions 7.95 -1.13 .0054Number of benzodiazepine prescriptions 32.47 4.72 <.0001Percent of opioid prescriptions with a sedative-hypnotic or carisoprodol prescription within 30 days .036 .005 .0003Number of inappropriate prescriptions .106 -.003 .0099
• Prescribers who use the PDMP the most increased prescribing after registering
• Prescribers who registered but never use the PDMP decreased prescribing after registering
Patient Overdose Outcomes, According to Registration Status of Prescribers
Patients whose providers were ALL
REGISTERED
Patients with AT LEAST ONE
REGISTERED provider and AT LEAST ONE NON-REGISTERED
provider
Patients with NO REGISTERED
providersN (%) N (%) N (%)
Total in the PDMP 540,889 663,059 517,132 Overdose death 150 (0.03%) 335 (0.05%) 70 (0.01%)Overdose hospitalization 1,045 (0.19%) 5,173 (0.78%) 519 (0.10%) p-valAny overdose event 1,195 (0.22%) 5,508 (0.83%) 589 (0.11%) <.0001No overdose events 539,694 (99.78%) 657,551 (99.17%) 516,543 (99.89%)
Conclusions• Following implementation of Oregon’s PDMP,
there was a statewide decline in:– per capita number of inappropriate prescriptions– MME dispensed– number of pills dispensed
• Despite the changes, the number of opioid- related deaths and overdose hospitalizations remained stable.
Conclusions• Contrary to our hypotheses, prescribers
who registered for the PDMP did NOT appear to decrease prescribing. In fact, they prescribed more.
• This trend was most apparent among registrants who made greatest use of the PDMP.
Conclusions• Among prescribers who did NOT register for
the PDMP, there were decreases in prescribing.
• Non-registered prescribers, who outnumbered registered prescribers roughly 10:1, may have accounted for the statewide trends.
Conclusions• Number of patients and number of prescriptions
increased among registered prescribers, and decreased among non-registered prescribers.
• Possible migration of patients from non-registered to registered prescribers who were most likely to use the PDMP, and perhaps most liberal in prescribing.
• Migration might account for some increases in prescribing among registered prescribers.
Conclusions• Overall statewide decline in opioid prescribing may
have resulted from a “surveillance effect,” in which prescribers perceived that their prescribing patterns were being scrutinized.
• Other factors in the environment were likely important, such as greater reporting of opioid prescribing and related mortality in the media and professional publications, new clinical guidelines, new reimbursement restrictions from Medicaid.
Study Limitations• Generalizable to states similar to Oregon:
states without mandatory registration or PDMP use, nor proactive alerts.
• Selection bias: providers who register for and use PDMP may have different treatment goals / patient panels.
• Difficult to parse out influence of PDMP from current environmental factors in prescribing.
Next Steps for PDMP Administrators and Health Plans
• Refinements in the program and supplementary policies may be necessary to improve the PDMP’s impact.
• Refinements might include the use of proactive alerts, mandatory registration, mandatory querying for new opioid prescriptions, and better training of clinicians in use of this relatively new innovation.
• Supplementary policies might include preauthorization for high-dose prescriptions or initial prescriptions for long-acting opioids, and “pill mill” laws.
*Many of these have been implemented in other states.
Next Steps for PDMP Research • Determine what factors influence the increase
in prescribing, especially risky prescribing, among those who use the PDMP.
• Understand how refinements to Oregon’s PDMP (e.g., mandatory use, proactive alerts) might affect prescribing patterns and ultimately patient care and outcomes.
Contact Information
Christi [email protected]
Sara [email protected]
Project Funding: National Institute on Drug Abuse, 1R01DA031208-01A1
For more information, please visit http://www.acumentra.org/PDMP/
Optimizing Prescriber Use of PDMP Data, Part 1
National Prescription Drug Abuse & Heroin SummitMarch 30, 2016
Cynthia Reilly, B.S. Pharm.Director, Prescription Drug Abuse Project
The Pew Charitable Trusts
The Pew Charitable Trusts’Prescription Drug Abuse Project
Goal: To help reduce the inappropriate use of prescription drugs while ensuring that patients with legitimate medical needs have access to effective pain control
– Expand the use of management tools, such as patient review and restriction programs, in Medicaid and Medicare
– Reduce the use of methadone for pain control in state Medicaid programs
– Improve state prescription drug monitoring programs
Pew’s PDMP-Related Activities• Fall 2012 - Prescription Drug Monitoring Programs: An
Assessment of the Evidence for Best Practices • April 2015 - A Five-Year Roadmap: Optimizing State
Prescription Drug Monitoring Programs from 2015 to 2020• May 2015 - PDMP Research Forum: Identifying Priorities to
Optimize Use and Improve Public Health• October 2015 - Is Poor Data Quality Impeding PDMP
Effectiveness? A Discussion Exploring Critical Data Quality Issue• June 2016 - Optimizing Prescriber Utilization of Prescription
Drug Monitoring Programs: Evidence-Based Practices and Strategies for Implementation
“…PDMPs are unlikely to reach their full potential in reducing prescription drug misuse and abuse and diversion if they are not utilized.”
Office of National Drug Control Policy, 2015
https://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/2015_national_drug_control_strategy_0.pdf
• On October 21, 2015, President Obama announced actions to address the prescription drug abuse and heroin epidemic
• Included a commitment by federal, state, local governments and the private sector to double the number of health care providers registered with their state PDMPs by 2017
https://www.whitehouse.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector
Optimizing Prescriber Utilization of Prescription Drug Monitoring Programs:
Evidence-Based Practices and Strategies for Implementation
• Unsolicited Reporting• Prescriber Use Mandates• Delegation• Data Timeliness• Streamlined Enrollment• Educational and Promotional Initiatives• Health Information Technology Integration• Enhanced User Interfaces
Key Questions
• What is the evidence demonstrating effectiveness of these practices?
• How are states implementing these practices?
• What implementation barriers were encountered and how were they overcome?
• What was the impact on PDMP resources?
• What is the extent of adoption of these practices by PDMPs nationwide?
Strategies for Implementing Change
• Assess current status• Analyze facilitators and barriers to change • Prioritize goals• Develop strategic plan • Implement• Assess• Modify, if needed
“PDMPs are more than just passive databases.”
Centers for Disease Control and Prevention
http://www.cdc.gov/drugoverdose/pdmp/states.html
Unsolicited Reports
• Proactive communications that alert users about potentially harmful drug use or prescribing activity based on the data contained in the PDMP• Based on thresholds associated with increased risk of
harm or abuse
• Notifications may be sent to:– Prescribers– Dispensers– Regulatory agencies– Law enforcement
Massachusetts’ Assessment of Unsolicited Reporting
• MA transitioned to electronic alerts in December 2013• Initial results:i
– 21 percent of prescribers who received an alert logged into the PDMP for the first time
– 59 percent of patients who were the subject of an alert sent the first month did not meet the threshold again for the next six months
– Prescriber survey (n = 87)• Only 24 percent were aware of all other prescribers providing
controlled substances to their patients• 85 percent said viewing PDMP data increased
confidence in prescribing decisions ihttp://www.pdmpexcellence.org/sites/all/pdfs/MA%20PMP%20electronic%20alert%20NFF.pdf
Massachusetts’ Assessment of Unsolicited Reporting (cont’d)
http://www.pdmpexcellence.org/sites/all/pdfs/MA%20PMP%20electronic%20alert%20NFF.pdf
Maine’s Progression in Use of Unsolicited Reports
• ME began sending unsolicited reports in 2005 via U.S. mail on a quarterly basis
• Electronic alerts now sent via e-mail on a monthly basis; mailed to unregistered prescribers
• 2009 survey of prescribersi
• Respondents who received an unsolicited report were significantly more likely to register with the database (73 percent) than those who did not receive the reports (27 percent)
• In 2014, added feature allowing prescribers to set their own thresholds
ihttp://digitalcommons.library.umaine.edu/cgi/viewcontent.cgi?article=1020&context=ant_facpub
Maine’s Progression in Use of Unsolicited Reports (cont’d)
ihttp://digitalcommons.library.umaine.edu/cgi/viewcontent.cgi?article=1020&context=ant_facpubhttp://www.pdmpassist.org/pdf/PPTs/National2012/2_Allain_StatePanelInnovationsIndiana.pdf
Indiana’s User-Led Unsolicited Reports
• In 2012, IN was one of the first states to launch “user-led” unsolicited reportsi • Reports generated by PDMP-registered prescribers and
sent to peers who prescribe to the same patient • Used information from licensing boards to email reports to
non-registrants—includes enrollment instructions • In the first two months, 68 percent of user-led reports
were sent to individuals not enrolled in the PDMPi
• Provides mechanism to promote registration and use
ihttp://www.pdmpassist.org/pdf/PPTs/National2012/2_Allain_StatePanelInnovationsIndiana.pdf
PDMPs Authorized, Engaged in Sending Unsolicited Reports to Prescribers
2006 201525%
35%
45%
55%
65%
75%
85%
67%
80%
30%
66%
Authorized Engaged
http://www.kms.ijis.org/db/share/public/PMIX/ijis_pmix_survey_ta_report_20070204.pdf; http://www.namsdl.org/library/BDC14250-C636-4E06-3EA3510BB665BF67/;The Pew Charitable Trusts and the Prescription Drug Monitoring Program Center of Excellence at Brandeis University, unpublished data.
Thank You
Cynthia Reilly, B.S. Pharm.Director, Prescription Drug Abuse Project
The Pew Charitable [email protected]
202-540-6916
www.pewtrusts.org/en/projects/prescription-drug-abuse-project
Optimizing Prescriber Use of PDMP Data, Part 2
National Prescription Drug Abuse & Heroin SummitMarch 30, 2016
John Eadie, MPADirector, PDMP Center of Excellence
Brandeis University
Origin of Prescriber Mandates to Use PDMPs
• Nevada law in 2007: Subjective Judgment – When prescriber believed patient trying to obtain
drugs for non-medical reason.– Increased from 4 to 19 annual requests per
prescriber.• Other states followed with subjective
mandates in specific circumstances
Comprehensive Prescriber Use Mandates
• Kentucky tried to increase voluntary prescriber use for 13 years by education.– By 2012 -- 27 annual requests per prescriber.– Found this inadequate.
• First comprehensive mandate in 2012: Law and Regulation– Must request PDMP data prior to initial Rx for drugs in
C-II, III and IV.– Must request again at least every 3 months for opioids
for pain and annually for other C-II, III and IV drugs.
Comprehensive Use Mandates – 1As of February 2016:
14 states have enacted comprehensive mandates
State – Effective Date • KY – July 2012• TN – April 2013• WV - May 2013• NY – August 2013• NM – April 2014• OH – April 2015 • CT – July 2015
State – Effective Date• PA – June 2015• NV – October 2015• NJ – November 2015• OK – November 2015 • RI – March 20I5• MA – January 2016 • NH – September 2016
Comprehensive Use Mandates - 2
• Comprehensive mandates are objective:– Apply to all prescribers – Apply at least for all initial opioid prescriptions.– Drugs included:
• All Schedule II, III and IV – 5 states• Opioids and benzodiazepines – 5 states• Opioids only – 3 states• Schedule II drugs for acute or chronic pain – 1 state
Comprehensive Use Mandates – 3
• Triggering events:– Initial Prescription for included drugs – 14 states– For continued treatment:
• All prescriptions – 1 state• At least every 90 days - 4 states• At least every 6 months – 3 states• At least annually – 3 states• No follow-up required – 3 states
Comprehensive Use Mandates – 4Exceptions to Mandates – most common:• Short duration prescriptions:
• 5 days or less if issued in Emergency Dept. – 3 states• 7 days or less – 3 states
(in 1 – excepted only if no refills)• 10 days or less – 1 state
• Terminally Ill Patients• Terminal Illness – 6 states• Terminal illness & under hospice care – 2 states
• Hospital or long term care in patients – 7 states• If PDMP is inaccessible, e.g. electrical failure – 5
states
Provision for Prescriber Delegates• Delegates can obtain PDMP reports for
prescribers, when state law permits.• Prescribers set up subaccounts• Prescribers can audit delegates’ use.• Prescribers are accountable for delegates’ use.
• All states with comprehensive prescriber use mandates permit delegates.
• By 2015, 40 states permit delegates.
Impact of Comprehensive Prescriber Use Mandates
• KY, OH and NY are tracking multiple measures to understand the impact of mandates
• The University of Kentucky assessed the impacts through the end of the first year, until July 2013.
– UK study available at: http://www.chfs.ky.gov/os/oig/KASPER.htm
University of Kentucky Evaluation of Mandate – First year - A
• Pharmacist registrations increased 322% & queries increased by 124%.
• Prescriber registration increased 262%.
• Mean annual queries per prescriber increased 550 percent, from 34 queries in 2009 to 221 in 2013.– Increase continued thereafter – see next slide.
Reports Requested Kentucky PDMP:2005 through 2015
University of Kentucky Evaluation of Mandate – First year - B
• Both opioid and benzodiazepine prescribing decreased.
• A reduction in CII – CIV Rx from 4 to 8%. – Reduction continued thereafter – decrease is 10%
by end of 2015 see next slide.
• But a “chilling effect” on opioid prescribing did not appear.
Kentucky Rx Submitted to PDMP:2005 through 2015
http://www.chfs.ky.gov/NR/rdonlyres/E5FDF281-27D7-44D4-8A60-D66A800A6A70/0/KASPERQuarterlyTrendReportQ42015.pdf
University of Kentucky Evaluation of Mandate – First Year - C
• High-dose oxycodone Rx decreased.
• # patients receiving Rx for combination of an opioid, benzodiazepine, and muscle relaxant, decreased by 30%.
• Hospital discharges and deaths decreased.
• While increase in heroin discharges and deaths increased, that started a year before HB1.
• Doctor Shopping decreased by over 50%.
New York State - A
• Registered prescribers increased by 77% within 6 months.
• Registered pharmacists increased 680% in the same period.
• Requests for reports increased from an average of 11,000 per month to 1.2 million per month within 6 months.
New York State - B
• Opioid Rx decreased by 8.72%, and individuals receiving an opioid Rx decreased by 10.4%.
• Yet, Rx for opioids commonly used in chronic cancer pain treatment (e.g. morphine and fentanyl) were not adversely affected.
• Buprenorphine prescriptions, used in treating opioid addiction, increased (14.6%) and the # of patients with this drug increased (12.8%) in the fourth quarter of 2013 as compared to the same quarter in 2012.
New York State - C• There was a 79.5% decrease in # of individuals
involved in multiple provider episodes by the the first full quarter of the mandate (the fourth quarter of 2013 compared to fourth quarter of 2012).
• This effect continued so, by the end of 2015 (two years and 5 months) individuals involved in multiple copy episodes decreased by 91.2%.
NY State: Multiple Provider Episodes and PDMP Report Requests, October 2011- December 2015
Note: Multiple provider episodes defined as patients using five or more prescribers and five or more dispensers within the month. Source: New York PDMP
Oct 2011
Dec 2011
Feb 2012
Apr 2012
Jun 2012
Aug 2012
Oct 2012
Dec 2012
Feb 2013
Apr 2013
Jun 2013
Aug 2013
Oct 2013
Dec 2013
Feb 2014
Apr 2014
Jun 2014
Aug 2014
Oct 2014
Dec 2014
Feb 2015
Apr 2015
Jun 2015
Aug 2015
Oct 2015
Dec 2015
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
0
50
100
150
200
250
300
350
400Multiple Provider Episodes and PDMP Report Requests, October 2011 - December 2015
Patients Meeting Multiple Provider Episode Threshold
PDMP Report Requests
Num
ber o
f PDM
P Re
port
Req
uest
s
Num
ber o
f Pati
ents
Mee
ting
Mul
tiple
Pro
vide
r Epi
sode
s Thr
esho
ld
Ohio
• Ohio began in 2011 with a subjective mandate. Some increases in PDMP registrations and requests for reports followed.
• While persons involved with multiple prescriber episodes decreased during the first year, that leveled off and began increasing again.
• Beginning in April 2015, Ohio’s mandate became comprehensive and impacts similar to KY and NY are now expected.
Contact Information
John Eadie, MPAPublic Health & PDMP Project Coordinator
National Emerging Threats InitiativeNational HIDTA Assistance Center
Phone: 518-429-6397Email: [email protected]
When PrescribersUse PDMP Data
Presenters:• Cynthia Reilly, Director, Prescription Drug Abuse Project, The Pew Charitable
Trusts• John L. Eadie, Coordinator, Public Health and Prescription Drug Monitoring
Program Project, National Emerging Threat Initiative, National HIDTA Assistance Center
• Sara Hallvik, MPH, Healthcare Analyst Manager, Acumentra Health• Christi Hildebran, LMSW, CADC III, Research Manager, Acumentra Health
PDMP Track
Moderator: Anne L. Burns, RPh, Vice President, Professional Affairs, American Pharmacists Association, and Member, Rx and Heroin Summit National Advisory Board