Clinicians’ Use of Prescription Drug Monitoring Programs in Clinical Practice and Decision-Making

• Published in: Pain medicine (Malden, Mass.) Mass.), 2017-06, Vol.18 (6), p.1063-1069
• Main Authors: Leichtling, Gillian J., Irvine, Jessica M., Hildebran, Christi, Cohen, Deborah J., Hallvik, Sara E., Deyo, Richard A.
• Format: Article
• Language: English
• Subjects: Clinical decision making; Clinical Decision-Making - methods; Decision making; Dentistry; Emergency medical care; Ethics; Female; Follow-Up Studies; Health Personnel - standards; Humans; Interviews as Topic - methods; Male; Opioids; Pain; Patients; Physicians - standards; Prescription Drug Monitoring Programs - standards; Prescription Drug Monitoring Programs - utilization; Prescription Drugs - therapeutic use; Primary care; PRIMARY CARE & HEALTH SERVICES SECTION; Qualitative research; Surgery; Therapeutic drug monitoring
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnw251

Abstract Objectives. Little is known about clinicians’ use of prescription drug monitoring program (PDMP) profiles in decision-making. The objective of this qualitative study was to understand how clinicians use, interpret, and integrate PDMP profiles with other information in making clinical decisions. Design. Qualitative interviews of clinician PDMP users. Setting. Oregon registrants in the state’s PDMP. Subjects. Thirty-three clinicians practicing in primary care, emergency medicine, pain management, psychiatry, dentistry, and surgery. Methods. We conducted semistructured telephone interviews with PDMP users. A multidisciplinary team used a grounded theory approach to identify patterns of PDMP use and how PDMP profiles influence clinical decisions. Results. PDMP use varied from consistent monitoring to checking the PDMP only on suspicion of misuse, with inconsistent use reported particularly among short-term prescribers. Primary care clinicians reported less routine use with existing pain patients than with new patients. In response to worrisome PDMP profiles with new patients, participants reported declining to prescribe, except in the case of acute, verifiable conditions. Long-term prescribers reported sometimes continuing prescriptions for existing patients depending on perceived patient intent, honesty, and opioid misuse risk. Some long-term prescribers reported discharging patients from their practices due to worrisome PDMP profiles; others expressed strong ethical grounds for retaining patients but discontinuing controlled substances. Conclusion. Greater consistency is needed in use of PDMP in monitoring existing patients and in conformity to guidelines against discharging patients from practice. Research is needed to determine optimal approaches to interpreting PDMP profiles in relation to clinical judgment, patient screeners, and other information.