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Only Half of Physicians Use Programs to Combat ‘Doctor Shopping’

A Only Half of Physicians Use Programs to Combat ‘Doctor Shopping’new study has suggested that only half of all doctors use prescription drug monitoring programs, which are designed to prevent “doctor shopping” by people seeking multiple prescriptions for controlled substances. The finding drives home the point that large-scale adoption of any program such as this takes time, but the finding also presents cause for concern about the ease of obtaining multiple prescriptions for opioid painkillers. The researchers, however, have identified some of the factors preventing doctors from making use of the programs, and the results could be used to guide improvements and get more physicians using the systems.

What Are Prescription Drug Monitoring Programs?

Prescription drug abuse is a widespread issue in the U.S., with much of the problem being driven by opioid painkillers such as oxycodone (OxyContin) and fentanyl (Duragesic), which have similar addictive properties and risks as heroin. According to the CDC, 120 people die every day in the U.S. as a result of drug overdose, and in 2013, almost 52 percent of these deaths were due to prescription medications. The majority of these overdoses involved painkillers, and the number of overdoses relating to the class of drugs has quadrupled since 1999. However, benzodiazepines (like Valium) were also implicated, being involved in just under one-third of overdose deaths in 2013.

“Doctor shopping” is a particular problem, which is the practice of going to multiple doctors with the same complaint—valid or not—with the aim of getting multiple prescriptions for the same issue. Because there was traditionally no centralized record of who had recently been prescribed controlled substances, doctors had no way of knowing if a patient was a doctor shopper. According to the National Institute on Drug Abuse, about 2 percent of opioid prescriptions in 2008 went to potential doctor shoppers, many of whom likely went on to sell the drugs on the streets.

Prescription drug monitoring programs (PDMPs) provide doctors with a centralized database for registering the prescriptions they make and to check if the patient has already received such a prescription. Currently, only two states (Missouri and Pennsylvania) don’t have such a program in place, and both are working toward establishing them.

Do Doctors Know About and Use PDMPs?

The study aimed to investigate whether physicians were aware of and regularly used PDMPs through a nationally-representative sample of 420 primary care doctors. The study showed that the vast majority of doctors—72 percent of the sample—knew of their state’s program, but only 53 percent reported using it. The lack of awareness from some was attributed to the fact that many such programs are fairly new, but the lack of use from those who did know about the programs is the main issue.

As you may expect, many doctors (58 percent) struggled to find the time to use their state’s program. Study author Lainie Rutkow suggests that states allow nurses and doctor’s assistants to check prescriptions. Another major issue is that the systems aren’t always easy to use, an issue reported by 28 percent of doctors in this study. California’s database is well-known for being difficult, and even the program’s administrator has testified about the problems he faces accessing information.

Steven Stack, president-elect of the American Medical Association, commented on his experience with Kentucky’s PDMP: “It's a useful tool. But every time I do it, I have to type in the patient's first name, last name, date of birth, Social Security number and street address.” Like Stack, 98 percent of doctors aware of their state’s program agreed that it is useful, but it’s clear that the process needs to be streamlined.

From a legal perspective, in most states doctors don’t have to check the PDMP database, with only New York and Tennessee making that check mandatory. (This is generally considered unnecessary, because not all doctors are in specialties likely to require it, and it would take more time to check the database with every eligible prescription.) A bill to make use of the program mandatory in New Jersey has been opposed by the state’s Medical Society, which argues that doctors should access it only when they have suspicions about a patient.

PDMPs Are Helpful but Need Improvement

The headline finding—that half of physicians don’t use their state’s program—initially suggests an almost negligent attitude, but it’s clear from the details of the study that this isn’t the case. There are early hiccups with any new system, and for doctors—who are incredibly busy people—these hiccups constitute a significant barrier. Legally forcing them to use PDMPs may initially seem appealing, but given that time constraints were the No. 1 barrier identified in this study, it might not be the best approach. If such legislative moves are made, they should at the very least be accompanied by other rules allowing nurses and assistants to use the system on a physician’s behalf to lighten the workload. With sensible regulations and general user-friendly improvements to the systems, PDMPs could easily make “doctor shopping” a thing of the past.

Posted on July 30th, 2015

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