Prescription monitoring programs underused in opioid epidemic
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Prescription monitoring program data, “a vital tool to help combat the potential harms associated with prescription opioid misuse,” were underutilized by health care professionals, researchers wrote in Pain Medicine.
The researchers also found that “many barriers exist” to prescription monitoring program (PMP) data use.
“The evidence on whether PMPs are effective in reducing inappropriate prescribing is mixed,” Alysia Robinson, MSc, a research assistant at the International Chronic and Complex Conditions Research Group in Nova Scotia, Canada, and colleagues wrote. “Identifying and acknowledging potential barriers to PMP use is an essential first step to optimize utilization.”
Robinson and colleagues conducted a systematic review of 53 studies published in the United States.
Of that total, 46 studies with 131,587 prescribers or dispensers included PMP data use. The overall pooled proportion (PP) of prescribers or dispensers who have ever used the data was 0.57 (95% CI, 0.48-0.66). The PP of ever using PMP data was 0.63 (95% CI, 0.43-0.81) among physicians and 0.57 (95% CI, 0.41-0.73) among pharmacists, and “did not differ significantly” between the groups, according to the researchers.
In 11 studies with 4,919 prescribers or dispensers that examined the frequency of PMP use, there was a low percentage who always used PMP when making prescribing or dispensing decisions, ranging from 0% to 68% (mean percentage = 18.7%).
In addition, among 32 studies with 11,266 prescribers or dispensers that discussed barriers to PMP data use, time constraint was the most commonly identified reason. Less common obstacles included system slowness (eg, systems “timing out” during data queries, lack of receiving information in a timely manner, sporadic updates, lag time in system updates) and lack of training or guidance on how to use a PMP.
“Usability including difficulty accessing or navigating the PMP and interpreting the data could promote a lack of confidence in using the PMP that may prompt health care providers to identify the need for better training or guidance,” Robinson and colleagues wrote.
Some health care providers said they did not see the value in PMP data because they felt they could rely on their instincts. Others also expressed concern that PMP hindered autonomy and risked patient privacy and satisfaction.
Other less commonly reported barriers to PMP use included:
- lack of incentives;
- unreliability and usability of the data;
- limits on who can be an authorized user;
- lack of information from other states;
- having the necessary technology;
- difficulties logging in; and
- limited awareness of its purpose.
The researchers warned that their findings may be subject to bias.
“It is likely that those who responded were more actively engaged in the use of PMPs and hold stronger opinions about PMPs,” Robinson and colleagues wrote. “This could have caused an overestimation of the proportion of health care providers who use PMPs and could have inflated the reporting of barriers.”
Regardless, the researchers said that obstacles to PMP use must be reduced or eliminated so the programs can reach “their fullest potential for health care providers, patients and the public.”