A recent study by researchers at Monash University found that prescription drug monitoring programs (PDMPs) can impact the clinical decisions of healthcare providers, leading to both positive and negative outcomes. for patients.
The systematic review analyzed the results of 39 studies conducted in the United States between 2005 and 2021 to understand how the use of PDMP influences the recommendations or actions of healthcare providers regarding a patient’s treatment.
PDMPs are a public health initiative designed to reduce the harms associated with increasing opioid prescribing. They use electronic databases that collect and monitor information on prescribing and dispensing “high risk” drugs to patients.
Monash Addiction Research Center (MARC) doctoral candidate Louisa Picco, who led the study, said previous research had examined the effects of PDMPs on population outcomes such as changes in prescribing. opioids, but little was known about the actual clinical decisions that health care providers make and the impact of those decisions on patients.
“This is the first systematic review to explore how the use of PDMP actually influences clinical decision making by healthcare providers. Understanding how the information in PDMPs inform clinical practice and patient outcomes is key to the success of these tools, ”said Ms. Picco.
The study analyzed how the use of PDMP influenced the clinical decision-making of healthcare providers, including physicians, nurse practitioners, dentists, osteopaths and pharmacists in various settings such as private practices. , hospitals and community pharmacies. He identified the use of PDMP influencing clinical decision-making regarding seven broad themes, including provision of controlled substances, refusal to prescribe or treat, risk mitigation strategies, communication, education and treatment. counseling, referrals and coordination of care, and stigma.
He found that the most common clinical decision was related to the provision of controlled substances, reported in 21 studies, with decreasing prescribing being the most common clinical decision.
“The information in PDMPs allows prescribers to make more informed drug procurement decisions because they can see all monitored drugs prescribed and dispensed to patients,” Picco said.
Another common clinical decision made by healthcare providers was to refuse to prescribe or treat patients, with 19 studies reporting various forms of refusal of medication or treatment. The use of PDMP has led some health care providers not to accept new patients or to refuse to prescribe opioids to new patients.
“Refusing to treat or provide medication can have adverse effects on patients and abrupt stopping of medication should be avoided whenever possible. Unfortunately, we found that this was a common clinical decision made by healthcare providers and was an unintended consequence of these tools, ”Ms. Picco said.
The review also found that PDMPs are effective in mitigating risks to patients by providing healthcare providers with a patient profile that would enable them to make informed decisions, such as prescribing an opioid antagonist, naloxone. The use of the PDMP has also encouraged discussions between healthcare providers and patients, improved communication between prescribers and pharmacists, and helped clinicians collaborate with other healthcare professionals or departments to coordinate care. ‘a patient.
Although there are currently no clinical guidelines or best practices for the use of PDMP, study results suggest that these may be of benefit in helping healthcare providers make appropriate clinical decisions. based on information provided by PDMPs and other clinical tools.
“Given the recent implementation of Victoria’s own real-time ‘SafeScript’ PDMP, these results are crucial for the successful adoption and use of PDMPs and for the future implementation planned in other states. ‘Australia,’ Ms Picco said.