Undergraduate Category: Health Sciences Degree Level: Bachelor of Science in Pharmacy Studies Abstract ID# 997
KaEe Doong and Daniella Gaccione
Community Pharmacist Involvement in Prescrip;on Drug Monitoring Programs Abstract
Electronic prescripEon drug monitoring programs were created in effort to reduce opioid abuse. However, the full impact of these programs has not been seen due to non-mandatory enrollment for all healthcare providers. Community pharmacists can help improve quality of care and play a more acEve role in the paEent-care process through the use of prescripEon drug monitoring programs (PDMPs). LimitaEons to implemenEng PDMP use in community pharmacy pracEce include administraEve burden, technical issues, and prescriber concerns. This arEcle addresses these concerns and emphasizes the importance of community pharmacists’ involvement in decreasing prescripEon drug abuse through the use of PDMPs. However, their impact is limited without mandatory involvement from other healthcare providers.
Background • • •
• • •
h`p://www.cdc.gov/drugoverdose/pdmp/index.html
Results and Discussion
According to the US Center for Disease Control and PrevenEon (CDC) – 44 people die each day from an overdose of prescripEon painkillers[1] The NaEonal InsEtute on Drug Abuse (NIDA) reported that the number of unintenEonal overdose deaths from prescripEon pain relievers has more than quadrupled since 1999[2] Several intervenEons implemented: primary prevenEon educaEon, overdose educaEon including naloxone distribuEon, expansion of treatment programs, proacEve law enforcement efforts to idenEfy doctor shopping and pill mills, development of evidence-based pracEce guidelines to reduce opioid overprescribing, and the creaEon and use of prescripEon drug monitoring programs (PDMPs)[3] PDMPs are state-run electronic databases that are used to record the prescribing and dispensing of controlled prescripEon medicaEons to paEents Research has shown a slower increase in opioid abuse in states that uElize PDMPs[4] According to the PrescripEon Drug Monitoring Program Training and Technical Assistance Center at Brandeis University, currently 49 states and Guam have operaEonal PDMPs; however, use varies across states[5]
• Pros:
• Cons:
o Improve quality of care: tool for pharmacists to assess adherence, idenEfy paEents at high risk for opioid abuse, and evaluate appropriateness o Reduce doctor shopping and fraudulent prescribing
o Technical problems: lag Eme between prescribing, dispensing, & recording, limited interoperability amongst states, and lack of PDMP standardizaEon o Prescribing and dispensing concerns: under-prescribing of controlled substances and lack of protocol for addressing diversion or abuse o Pharmacy issues: large administraEve and Eme burden and lack of incenEve • Addressing Concerns: o Ethical duty of healthcare professionals to improve paEent care o PDMPs only require one computer and at least one educated pharmacist to operate smoothly (regardless of size and locaEon of pharmacy) o Study should be performed to determine cost associated with PDMP usage in community pharmacies to address concern of lack of reimbursements o The pharmacist’s role is to serve as an addiEonal check prior to distribuEon o MandaEng use of PDMPs in community pharmacies will not be successful unless prescribers are required to do the same o Pharmacists have limited opEons for resoluEon when encountering inappropriate prescripEon use § They can either not fill the prescripEon or send the paEent back to the prescriber, and neither opEon is beneficial or efficient
Conclusion
h`p://www.pdmpassist.org/pdf/Mandatory_Query.pdf
References: [1] CDC (2015), Injury PrevenEon & Control: PrescripEon Drug Overdose; [2] NIDA (2014), America’s AddicEon to Opioids: Heroin and PrescripEon Drug Abuse; [3] NIDA (2015), What is the Federal Government Doing to Combat the Opioid Abuse Epidemic; [4] UIW Pharmacy Review (2014), PrescripEon Drug Monitoring Programs: A Tool for Pharmacists; [5] PDMP TTAC (2016), PDMP Maps and Tables
PDMPs should be employed and mandated in community pharmacies to improve paEent outcomes and combat the opioid epidemic ager the issues idenEfied have been addressed. Pharmacists involvement will improve quality of care and reduce overprescribing, doctor shopping, pill mills, and drug diversion. Successful implementaEon of PDMPs will benefit healthcare providers, paEents, the public, law enforcement, public health agencies, and the funders of healthcare, but this impact can only be achieved with consistent and mandatory usage of PDMPs with appropriate educaEon, tools, and resources in the collaboraEve care process.