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Prescription Drug Monitoring Programs: A Rapid Qualitative Review

Last updated: April 30, 2019
Project Number: RC1097-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. How do healthcare providers (prescribers and dispensers) who prescribe monitored drugs use prescription drug monitoring programs?
  2. What are their perspectives on and preferences for prescription drug monitoring programs, including specific design and administrative features?

Key Message

Health care providers found prescription drug monitoring programs (PDMPs) useful for their practice in most instances however not routinely. PDMP use was either subjective, prompted by a concerning interaction with a patient about controlled substances; or systematic, mandated by institutional policy. PDMP use appeared to vary based on the provider’s personal preconceptions, institutional circumstances and professional judgement in terms of who genuinely requires treatment, or who may be doctor shopping. PDMP use helped determine barriers that were experienced and enablers that were most relevant to providers. Use was delineated into three broad functions including an information function, a patient safety function, and an engagement function. While several benefits to PDMPs were raised, challenges were also noted. These challenges included anticipated negative patient response to learning their providers accessed PDMP information; finding time and dedicated space in a busy pharmacy or medical practice to appropriately engage in discussion with patients; challenges in accessing the system, either due to lack of time or challenges with the interface (e.g., losing passwords, finding the website, entering patient data, a need for in-person authentication); and timely updates of the PDMP system which may lead to incomplete or inaccurate information. Suggestions for increased adoption and sustained PDMP use included better integrating PDMPs into clinical workflows, integrating PDMPs into existing electronic health record systems or developing a national linked system. Suggestions for specific design features include real time updating of prescription information; stronger user-friendly display to ensure the most relevant information is available for efficient prescribing decisions, a streamlined login process and automatic enrollment. Training was also identified as important and thought to include guidance on how to interpret information, strategies to incorporate PDMPs into clinical workflow, and how to approach patients for engagement discussions based on PDMP information.