Prescription Drug Monitoring Programs: Relationships Among Program Awareness, Use, and State Mandates.

The inappropriate use of opioids in the United States has increased markedly and has resulted in a tragic loss of lives. To combat this problem, prescription drug monitoring programs (PDMPs) have been instituted in most states. Use of the programs is voluntary for prescribers in some states, whereas in other states it is mandatory. The current study used a self-report survey instrument that was administered to 223 participant physicians. The goal of the study was to compare awareness and use of the PDMP in a state that mandates use (Ohio) with one that does not (North Carolina). Although awareness was not significantly different between respondents from the two states, self-reported use was significantly higher in the state mandating use (Ohio post-mandate vs. Ohio pre-mandate: 64% vs. 51%; χ2 = 15.66, P < .0001; and Ohio post-mandate vs. North Carolina: 64% vs. 42%; χ2 = 12.76, P < .0001). Based on these results, mandating use may be an effective method to increase PDMP utilization.

The utility and financial implications of obtaining routine lead levels for child psychiatric inpatients.

This study attempted to challenge the CDC recommendations regarding routine screening blood lead levels in children. The purpose was to determine the efficacy of obtaining routine lead levels on all patients admitted to a child psychiatric inpatient unit. A retrospective chart review of children admitted to a psychiatric inpatient unit during a 12 month period. The audit determined average lead levels and costs associated with the screening program. 1 of 61 admitted children was found to have an elevated lead level. Number needed to treat was determined to be 98. The cost per case detected was determined to be over $8,600. Routine screening for blood lead levels in all children admitted to a psychiatric inpatient unit does not appear efficacious or cost effective.

Influencing controlled substance prescribing: attending and resident physician use of a state prescription monitoring program.

OBJECTIVE: The purpose of this study is to evaluate the influence of attending physician awareness and utilization of a state prescription monitoring program on resident physician behavior. DESIGN: Twenty-five attending physicians and 70 residents in Emergency Medicine, Internal Medicine, Neurology, Pediatrics, and Psychiatry completed an 11-item questionnaire assessing awareness and utilization of a state prescription drug monitoring program. RESULTS: Residents who used the system had, on average, a higher proportion of supervising attendings using the system; residents required to utilize the system had the highest proportion of attendings using the system. Overall, almost 90% of the physicians who utilized the system did so due to concerns surrounding prescription drug abuse. Over one third of attending physicians reported increasing the quantity or amount of medication prescribed after utilizing the system, while no residents reported similar outcomes. Through the behavioral influence of supervising attending physicians, residents were significantly more likely to utilize the system. If system utilization is desired, attendings should use the system and require resident participation.

The utility and financial implications of obtaining routine laboratory screening upon admission for child and adolescent psychiatric inpatients.

The authors retrospectively explored the utility and fiscal implications of obtaining routine laboratory screening upon admission for child and adolescent psychiatric inpatients. A chart review of 153 sequential admissions (142 unique patients, with 11 patients admitted twice) over a recent 4-month period was conducted. Overall, 97.2% of all subjects who received a screening laboratory test had at least one abnormal finding. However, only four test results (<0.5%) actually had an impact on the psychiatric treatment plan or required immediate medical attention. With an average cost per patient for the full screening battery of $33-$122 and an average yearly direct cost to the inpatient unit of almost $38,000, potential alternatives to routine admission screenings are discussed. Given the cost of this relatively low yield outcome, these findings have important implications for psychiatric practice and cost-benefit analyses, which need to be further evaluated to better determine the actual utility of routine laboratory examinations upon admission.

Awareness and utilization of a prescription monitoring program among physicians.

In 2011, 5 years after the implementation of a statewide prescription monitoring program (PMP) in Ohio, a survey was distributed to physicians in five specialty areas. During the study period, 95 of 156 surveys were returned, for a 61% response rate. The purpose of the questionnaire was to assess utilization rates as well as reasons for accessing the PMP database and any influence the database may have had on prescribing practices. Over 84% of respondents were aware of the existence of the state PMP. However less than 59% of the respondents who were aware of the program had ever used it. Medical specialty was found to have a significant impact on both awareness and utilization of the system, with pediatric physicians least likely, and emergency physicians most likely, to be aware of and utilize the state PMP. Recommendations based on the authors' survey results include targeting pediatric and internal medicine providers for increased education regarding awareness and benefits of PMP utilization.