Safe Prescribing and Use of Opioids April 10-12, 2012 Walt Disney World Swan Resort
Accepted Learning Objectives:1. Analyze current professional educationprograms on safe use of opioids and newprograms under development.2. Explain a potentially transformative on-lineeducational tool for health professionals thatenable them to train by interacting with “virtualpatients.”3. Describe a Massachusetts program for trainingphysicians on safe opioid prescribing, and thecurriculum developed to teach residentsand faculty.
Disclosure Statement• Dr. Daniel P. Alford and Sarah Ball have disclosed no relevant, real or apparent personal or professional financial relationships.• Benjamin Lok has disclosed that he has a relationship with Shadow Health, Inc.
The South Carolina Opioid Safe Use Initiative (SCOSI) Blending academic detailing and a prescription drug monitoring program to reduce opioid misuse and optimize opioid safe use in pain managementSarah Ball, Pharm.D.Program Director for Academic Detailingand Assistant ProfessorSouth Carolina College of PharmacyUniversity of South Carolina (USC)/Medical University of SCApril 11, 2012
SCOSI• FDA planning grant to improve safe use of opioids – Awarded to the South Carolina College of Pharmacy (SCCP) at USC• Three major components – Academic Detailing (SCORxE) – Prescription Drug Monitoring (SCRIPTS) data – Stakeholder Involvement
SCOSIGiven the risks of opioid abuse/misuse, diversion, addiction, toleranceand drug side effects, physicianeducation and engagement is key inhandling pain management andappropriate use of opioids in patientsof all ages
Academic Detailing: Social marketing for better clinical practice Evidence Practice– Frank May MAppSci(Pharm), FISPE, DATIS Service Director
Academic Detailing: A ‘New’ Old Concept― Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based detailing. N Engl J Med 1983;308:1457-63.― “Sound data on clinical pharmacology and cost issues could be used to improve physicians’ prescribing decisions if that information were presented in an educational outreach program that was rooted in established principles of behavioral science, market research, and communications theory.”
Academic DetailingPersonalized support for good clinicaldecision-making through: ― Periodic face-to-face encounters • Trained health professionals visit clinicians in their practice settings, often one-to-one • Discuss topics of interest • Deliver key evidence-based messages to facilitate better patient care • Unbiased by commercial or other extraneous interests ― Useful support services between visitsGoal – to optimize practice patterns
Academic Detailing: Does it Work? Median adjustedComparison Outcomes risk difference (RD) Compliance with desired practice 5.6% (IQR* = 3-9%)Academic (n =34) Dichotomousdetailing and no (n = 37) Prescribing (n =17) 4.8% (3-6.5%)intervention Non-prescribing (n = 17) 6% (IQR 3.6-16%)Comparison Outcomes Median differenceAcademic Continuous Improvement fromdetailing and no 21% (IQR 11-41%) (n = 19) baseline (n = 17)intervention*IQR = interquartile rangeO’Brien et al. Cochrane Database of Systematic Reviews 2007, Issue 4.
Academic DetailingTrusting Relationships formed between academic detailers, physicians and other healthcare practitioners can become the spearhead for many clinical practice improvement strategies
What is SCORxE?Academic Detailing Service implemented by SCCP inNov 2007 through grant funding provided by SC DHHS ― Visits from trained clinical pharmacists on clinically relevant topics ― Address barriers to change in practice and prescribing ― Promote optimal, evidence-based treatment decisions, regardless of medication coverage plans ― Resource available to research and answer any medication-related questionCan focus on any clinically relevant topic to addressgaps between evidence-based treatment andpracticeSC DHHS: South Carolina Department of Health and Human Services
SCORxE Snapshot• Interactive office visits on 5 Provider participation* clinical topics Ave visit: 30.9 minutes• Development of scientifically sound, user-friendly provider 46.7% asked questions packets on 6 clinical topics requiring follow-up – Physicians ‘love the materials’• Expansion from 6 to 18 20% completed CME counties 99% agreed to next• Reinforcement through visit** subsequent visits * Nov 2007 – Sept 15, 2011 – “Follow-up on topic is good. It ** Providers visited on a topic agree to a return visit helps keep me motivated.”
Prescription Monitoring Program (PMP) State program that collects data, stores data, and generates reports on some set of controlled prescription drugs ― Also referred to as Prescription Drug Monitoring Program (PDMP) ― Data collection includes patient, prescriber, dispenser and drug information available on a prescription ― Report generation differs across state programs (may be proactive or reactive) Offers unique opportunity to inform physicians of the scope and magnitude of prescription drug abuse and “doctor shopping” Carnevale and Associates, LLC. (2011). Policy Brief. Available at: http://www.carnevaleassociates.com/pmp_brief_4-13-11.pdf
Prescription Monitoring Program An Untapped Resource The potential value of PMPs inhelping physicians make moreinformed decisions for prescribing opioids has beenaccepted by many stakeholders in thepain management, substance abuseand public health and safety arenas.
What is SCRIPTSThe South Carolina PMP legislated by the SC GeneralAssembly in 2006 to respond to prescription drug abuse ― Went into effect Feb 2008 ― Established and maintained by the Bureau of Drug Control at SC DHEC ― Tracks all dispensed controlled substances in Schedules II, III and IV ― As of Mar 2012, over 40.3 million dispensing records in the databaseIntent is to identify and stop diversion of prescriptiondrugs without impeding appropriate use of licitcontrolled substancesSC DHEC: South Carolina Department of Health and Environmental Control
SCOSI Stakeholders• Interdisciplinary team with interest in opioid safety who offer collective expertise in: – De-identified data analyses and evaluation – Academic detailing – PMPs (includes Brandeis University PMP COE) – Prescription drug abuse – Medical education on opioid use and pain management• Unique opportunity to identify cost-effective public health and safety strategy that addresses both opioid abuse and appropriate, safe opioid use COE: Center of Excellence
SCOSI Will Develop an Academic Detailing Strategy to Optimize Pain Management and Increase Utility of PMPs• Develop user-friendly, evidence-based academic detailing materials on pain management and opioid use – Data driven research from SCRIPTS data can refine intervention strategy and selection of key messages• Interactive office visits to promote best treatment decisions about pain management and opioid prescribing• Increase physicians’ awareness of SCRIPTS• Engage physicians in the use of the SCRIPTS database – Offer Performance Improvement Continuing Medical Education (CME) for opioid prescribing self-audits
Blending Two Unique and Useful Strategies for Safe Prescribing and Use of Opioids SCORxE SCRIPTSEffective interactive technique to Does not offer latest scientificdeliver physician education on optimal knowledge on medication use andpain management and opioid patient care decisionsprescribingRarely has access to real-time data Provides real-time data to monitor for potential opioid abuseIncrease physicians’ awareness of An untapped resource that isSCRIPTS and assist with access/use of underutilizedSCRIPTS data reportsAddress barriers to change in practice Data resource to track changes inand prescribing practice patterns
A Blueprint to Serve as a National Model for Safe Prescribing and Use of Opioids Academic Detailing PMP or PDMPEffective interactive technique to Does not offer latest scientificdeliver physician education on optimal knowledge on medication use andpain management and opioid patient care decisionsprescribingRarely has access to real-time data Provides real-time data to monitor for potential opioid abuseIncrease physicians’ awareness of An untapped resource that isPMP/PDMP and assist with access/use underutilizedof PMP/PDMP data reportsAddress barriers to change in practice Data resource to track changes inand prescribing practice patterns