The document discusses new developments in prescription drug monitoring programs (PDMPs) in California, Colorado, and Minnesota. It provides an overview of presentations given on upgrades to the PDMP systems in each state. Key points include: Colorado's PDMP has enhanced data reporting requirements and streamlined data retrieval; Minnesota's PDMP has focused on improving data quality and compliance; and California's upgraded PDMP (CURES 2.0) features automated registration, delegation of authority, patient flagging, peer-to-peer communication on patient safety, and de-identified data sets.
1. Two states, South Carolina and Wisconsin, improved integration of PDMP data into electronic health systems by establishing connections between their PDMPs and various health IT platforms like EMR systems and pharmacy dispensing software.
2. States face challenges with PDMP integration like legal definitions of access, costs of integration projects, and establishing necessary agreements and user authorizations.
3. Florida operates drug surveillance systems through a medical examiners commission and PDMP. Analysis found declines in prescription opioid overdoses after implementation of legislative and regulatory interventions including a PDMP in 2011. However, heroin overdose deaths increased as some shifted to heroin.
This document discusses ensuring access to quality substance use disorder (SUD) treatment. It outlines federal laws like the Mental Health Parity and Addiction Equity Act and Affordable Care Act that are intended to improve access to SUD treatment. It also discusses some state parity laws. While progress has been made in expanding coverage for SUD treatment, barriers still exist like limits on services and lack of providers. Enforcement of these laws is needed to fully achieve parity and reduce denials of medically necessary care.
This document discusses dangerous opioid prescribing practices observed in workers' compensation claims and strategies to address them. It provides an overview of opioid use and outcomes in workers' compensation populations. Specific cases are presented that exemplify dangerous prescribing patterns, including high doses and long-term use. Approaches used by organizations to identify at-risk patients and claims are outlined, such as monitoring prescription data and conducting urine drug screens. Initiatives to resolve issues include education, implementing prescribing guidelines, interdisciplinary treatment teams, and coordinating care for patients needing detoxification or behavioral health support.
This document summarizes a presentation given by Demetra Ashley of the DEA about regulations and efforts to address the prescription drug abuse epidemic. It discusses how most prescription drug abuse involves obtaining medications from friends and family, not through criminal means. The DEA works with various groups to educate on responsible prescribing and dispensing through initiatives like take-back events and conferences. The goal is to curb abuse while ensuring access to needed medications through enforcement as well as prevention and treatment efforts.
This document provides information about an advocacy track presentation on advocating for change related to addiction issues. The presentation features Gary Mendell, founder and CEO of Shatterproof, and Kim Manlove from the Indiana Addictions Issues Coalition. They will discuss strategies for influencing legislation and how people in recovery can become advocates. The learning objectives focus on advocating for state laws on PDMP usage, explaining strategies to influence legislation, describing how people in recovery can advocate, and providing counsel as part of a treatment team. The presentation then provides details on Shatterproof's story, the overdose epidemic, solutions for different populations, and legislative accomplishments in various states related to expanding access to naloxone and mandating PDMP usage.
This document summarizes a presentation on using prescription drug monitoring program (PDMP) data for public health purposes. State and local health officials in Washington State work with de-identified PDMP data to coordinate opioid abuse prevention and mitigation efforts. Examples are given of data reports generated for counties, including opioid prescribing rates, concurrent opioid and benzodiazepine prescriptions, and changes over time. Challenges with PDMP data are discussed, such as de-duplicating patient records and processing large datasets. The goal is to provide actionable information to local jurisdictions to inform resource allocation and policies.
This document summarizes a presentation on best practices for treating opioid addiction in the criminal justice population. It outlines the challenges of treatment in this population and identifies best practices for using medication-assisted treatment (MAT) and behavioral therapy. The presentation reviews key points from the ASAM National Practice Guideline, including that MAT is the standard of care for opioid use disorder and should be continued, initiated, or made available for inmates. Discontinuing treatment can be dangerous and contradicts evidence-based practices. The implications discussed are that the guideline supports higher quality care for inmates and a rehabilitative approach, while also helping to address the opioid epidemic.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
1. Two states, South Carolina and Wisconsin, improved integration of PDMP data into electronic health systems by establishing connections between their PDMPs and various health IT platforms like EMR systems and pharmacy dispensing software.
2. States face challenges with PDMP integration like legal definitions of access, costs of integration projects, and establishing necessary agreements and user authorizations.
3. Florida operates drug surveillance systems through a medical examiners commission and PDMP. Analysis found declines in prescription opioid overdoses after implementation of legislative and regulatory interventions including a PDMP in 2011. However, heroin overdose deaths increased as some shifted to heroin.
This document discusses ensuring access to quality substance use disorder (SUD) treatment. It outlines federal laws like the Mental Health Parity and Addiction Equity Act and Affordable Care Act that are intended to improve access to SUD treatment. It also discusses some state parity laws. While progress has been made in expanding coverage for SUD treatment, barriers still exist like limits on services and lack of providers. Enforcement of these laws is needed to fully achieve parity and reduce denials of medically necessary care.
This document discusses dangerous opioid prescribing practices observed in workers' compensation claims and strategies to address them. It provides an overview of opioid use and outcomes in workers' compensation populations. Specific cases are presented that exemplify dangerous prescribing patterns, including high doses and long-term use. Approaches used by organizations to identify at-risk patients and claims are outlined, such as monitoring prescription data and conducting urine drug screens. Initiatives to resolve issues include education, implementing prescribing guidelines, interdisciplinary treatment teams, and coordinating care for patients needing detoxification or behavioral health support.
This document summarizes a presentation given by Demetra Ashley of the DEA about regulations and efforts to address the prescription drug abuse epidemic. It discusses how most prescription drug abuse involves obtaining medications from friends and family, not through criminal means. The DEA works with various groups to educate on responsible prescribing and dispensing through initiatives like take-back events and conferences. The goal is to curb abuse while ensuring access to needed medications through enforcement as well as prevention and treatment efforts.
This document provides information about an advocacy track presentation on advocating for change related to addiction issues. The presentation features Gary Mendell, founder and CEO of Shatterproof, and Kim Manlove from the Indiana Addictions Issues Coalition. They will discuss strategies for influencing legislation and how people in recovery can become advocates. The learning objectives focus on advocating for state laws on PDMP usage, explaining strategies to influence legislation, describing how people in recovery can advocate, and providing counsel as part of a treatment team. The presentation then provides details on Shatterproof's story, the overdose epidemic, solutions for different populations, and legislative accomplishments in various states related to expanding access to naloxone and mandating PDMP usage.
This document summarizes a presentation on using prescription drug monitoring program (PDMP) data for public health purposes. State and local health officials in Washington State work with de-identified PDMP data to coordinate opioid abuse prevention and mitigation efforts. Examples are given of data reports generated for counties, including opioid prescribing rates, concurrent opioid and benzodiazepine prescriptions, and changes over time. Challenges with PDMP data are discussed, such as de-duplicating patient records and processing large datasets. The goal is to provide actionable information to local jurisdictions to inform resource allocation and policies.
This document summarizes a presentation on best practices for treating opioid addiction in the criminal justice population. It outlines the challenges of treatment in this population and identifies best practices for using medication-assisted treatment (MAT) and behavioral therapy. The presentation reviews key points from the ASAM National Practice Guideline, including that MAT is the standard of care for opioid use disorder and should be continued, initiated, or made available for inmates. Discontinuing treatment can be dangerous and contradicts evidence-based practices. The implications discussed are that the guideline supports higher quality care for inmates and a rehabilitative approach, while also helping to address the opioid epidemic.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
The document outlines state responses to prescription drug and heroin abuse presented at an advocacy track session. It includes presentations from officials in Arizona, Virginia, and New Mexico on their state's strategies. Arizona's presentation focuses on the state's prescriber report cards. Virginia's presentation discusses the governor's task force recommendations and a new health and criminal justice data committee. New Mexico's presentation describes the state's high overdose rates and model of stakeholder collaboration to reduce overdose deaths.
Rx16 federal tues_330_1_spitznas_2baldwin_3welchOPUNITE
This document discusses patient review and restriction programs (PRRs) as tools to help curb prescription drug abuse and coordinate patient care. It describes state Medicaid PRR programs and recent efforts to expand PRR programs to Medicare. It also describes the role of PRR programs in the CDC's Prescription Drug Overdose Prevention for States grant program, the Office of National Drug Control Policy's national strategy, and the federal budget.
This document summarizes a presentation on technologies to reduce prescription drug diversion, fraud, and abuse through electronic prescribing and drug deactivation systems. It discusses Delaware's pilot program with an at-home drug deactivation system. The presentation describes how electronic prescribing of controlled substances can reduce diversion and fraud while improving patient satisfaction. It also outlines DEA requirements for electronic prescribing and discusses Cambridge Health Alliance's experience implementing electronic prescribing of controlled substances with Epic and Imprivata. Finally, it summarizes the results of Delaware's pilot program, which provided at-home drug deactivation systems to specific pharmacies to promote safe disposal of unused prescription drugs.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
This document provides a summary of a presentation on the risks of medical marijuana and marijuana legalization. It begins with disclosures from the presenters and outlines six learning objectives. It then discusses concerns that marijuana is addictive, especially for those who start using it early, and impacts adolescent brain development. The document notes the lack of evidence that marijuana is effective for the conditions it is claimed to treat. It also discusses the risks of increased diversion of marijuana to youth and greater social acceptance of marijuana use negatively impacting public health. The document concludes with messages on how to discuss these issues with the public.
This document summarizes a presentation on engaging physicians in prevention efforts to address the opioid epidemic. It was presented by Yngvild Olsen and included the following key points:
1. Multiple policies like PDMPs, medication-assisted treatment, and naloxone access need to work together to reduce opioid misuse and overdoses.
2. Programs that educate physicians about prescription drug abuse and its link to heroin, and engage them in prevention, screening, and treatment can help address the epidemic.
3. Expanding access to evidence-based treatment with medications like buprenorphine and naloxone, combined with behavioral therapies, can help manage opioid addiction as a chronic disease
Web rx16 prev_tues_200_1_bretthaude-mueller_2scott_3debenedittis_4cairnes copyOPUNITE
This presentation covered multi-media prevention strategies for issues like prescription drug overdoses. It discussed the CDC's digital Rx drug prevention campaign, best practices for digital messaging, and programs using expectancy challenge theory and media literacy education in schools. Presenters included representatives from the CDC, Media Literacy for Prevention, and the Hanley Center Foundation who discussed their work developing and implementing digital communications and single-session prevention programs.
Revised order rx16 pdmp wed_1115_1_eadie_2reilly_3hallvik_4hildebranOPUNITE
This document summarizes a presentation on a study examining how prescriber registration and use of a prescription drug monitoring program (PDMP) in Oregon impacted opioid prescribing patterns and patient outcomes. The study found that statewide opioid prescribing generally decreased over time, but prescribers who registered for the PDMP prescribed more after registering, especially those who used the PDMP most frequently. In contrast, prescribers who did not register prescribed less. Patients whose providers were all registered had lower overdose rates than those with some registered and some non-registered providers. The conclusions were that PDMPs may need refinements like mandatory use to optimize their impact on prescribing and outcomes.
Rx16 federal tues_1115_1_fretwell_2gabbert-wilkebrownOPUNITE
This document summarizes a presentation on state and community-level programs for preventing prescription drug misuse and expanding treatment options like medication-assisted treatment. Speakers from Georgia and Iowa discussed their strategies for engaging stakeholders, implementing prevention initiatives in targeted communities, leveraging funding sources, and addressing challenges in data and addressing disparities. Iowa described their efforts to expand access to medication-assisted treatment for opioid use disorders through a new grant, including challenges implementing changes quickly.
This document summarizes a panel discussion on improving utilization of prescription drug monitoring programs (PDMPs). The panel will discuss current practices for interstate sharing of PDMP data, strategies for integrating PDMP data into healthcare records, and lessons from Washington state's program providing organizations access to PDMP data. The goal is to identify best practices that can be implemented in other states to increase interoperability and utilization of PDMP data.
This document summarizes a presentation on state and federal responses to the opioid epidemic. It discusses innovations from the Kentucky Attorney General including legislative measures targeting pill mills and heroin, programs to expand treatment and recovery, and education initiatives. It also describes the federal response through the Organized Crime Drug Enforcement Task Force (OCDETF), including their national heroin initiative targeting criminal organizations trafficking illegal opioids and heroin, and partnerships with other agencies to address public health and public safety aspects of the epidemic. The presentation outlines strategies at both state and federal levels aimed at improving access to treatment while also enforcing penalties on dealers through investigation and prosecution efforts.
Web only rx16 pdmp-tues_330_1_kreiner_2ringwalt-schiroOPUNITE
This document discusses three projects in North Carolina aimed at reducing harm from prescription drug abuse: 1) Identifying prescribers who prescribe very high levels of controlled substances using PDMP data and algorithms, in partnership with state agencies and the medical board. 2) Identifying prescribers with multiple patients who died from opioid-related overdoses. 3) Providing immediate feedback to prescribers on high-risk patients through electronic health records integrated with PDMP data, in partnership with health systems. The goals are to develop valid methods to identify problematic prescribing patterns using multiple data sources and address technical and policy hurdles to information sharing.
The panel discussion focused on how workers' compensation formularies can reduce opioid prescriptions. Formularies in states like Texas, Ohio, Oklahoma, and Washington were examined. The panel identified best practices for designing and implementing an effective formulary, and discussed stakeholders affected by formularies. Key factors in Texas' successful formulary were identified, as were lessons that can be learned from other states' experiences. The discussion addressed challenges like treating chronic pain if opioids are prescribed less and managing "legacy claims."
This document summarizes presentations from public health officials in North Carolina and Northern Kentucky on community responses to the heroin epidemic. Key points include:
- Officials from North Carolina and Northern Kentucky outlined programs and partnerships implemented in their regions to address rising rates of opioid and heroin abuse, including treatment programs, harm reduction strategies, legislation, and education initiatives.
- Data presented showed increasing rates of overdose deaths, neonatal abstinence syndrome, and infectious diseases associated with intravenous drug use such as hepatitis C in Northern Kentucky.
- Community leaders and advocates in Northern Kentucky have worked to raise awareness, pass legislation to expand access to treatment, and establish prevention and support networks to address the heroin epidemic impacting the region.
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
This document summarizes a presentation on advances in treating chronic pain and addiction. It includes:
- Presenters from PRIUM, American Airlines, and the Treatment Research Institute
- Learning objectives around chronic pain, psychosocial issues, Medicaid requirements for the ASAM Criteria, and implementing the criteria
- Disclosures from presenters about relevant relationships
- Overview of topics like the bidirectional relationship between physical and mental health, impacts of adverse childhood experiences, and the influence of stigma on substance use treatment
- American Airlines' workers compensation program which saw a 40% reduction in claims and lower pharmacy costs and disability after redesigning their approach to focus on early intervention and additional resources for employees with chronic
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
8 pharmacy track pharmacists working with local coalitions and pdm psOPUNITE
This document summarizes a presentation on pharmacists working with local coalitions and prescription drug monitoring programs (PDMPs). It discusses Nicole O'Kane presenting on how pharmacists can utilize PDMPs to screen for safety concerns and optimize patient care. It also discusses Kristina Clark and Christina Merino presenting on how a local coalition in Coffee County, TN engaged pharmacists and other stakeholders to reduce prescription drug abuse through education, monitoring, and evaluation.
This document discusses prescriber viewpoints on how mandating prescription drug monitoring program (PDMP) compliance is working. It provides an overview of presentations from three physicians on their experiences with PDMP mandates in Kentucky, West Virginia, and New York. The physicians evaluate the impact of mandates requiring prescribers to check the PDMP before prescribing opioids. They describe changes in prescribing patterns, attitudes towards the mandates, and recommendations for other states.
The document outlines state responses to prescription drug and heroin abuse presented at an advocacy track session. It includes presentations from officials in Arizona, Virginia, and New Mexico on their state's strategies. Arizona's presentation focuses on the state's prescriber report cards. Virginia's presentation discusses the governor's task force recommendations and a new health and criminal justice data committee. New Mexico's presentation describes the state's high overdose rates and model of stakeholder collaboration to reduce overdose deaths.
Rx16 federal tues_330_1_spitznas_2baldwin_3welchOPUNITE
This document discusses patient review and restriction programs (PRRs) as tools to help curb prescription drug abuse and coordinate patient care. It describes state Medicaid PRR programs and recent efforts to expand PRR programs to Medicare. It also describes the role of PRR programs in the CDC's Prescription Drug Overdose Prevention for States grant program, the Office of National Drug Control Policy's national strategy, and the federal budget.
This document summarizes a presentation on technologies to reduce prescription drug diversion, fraud, and abuse through electronic prescribing and drug deactivation systems. It discusses Delaware's pilot program with an at-home drug deactivation system. The presentation describes how electronic prescribing of controlled substances can reduce diversion and fraud while improving patient satisfaction. It also outlines DEA requirements for electronic prescribing and discusses Cambridge Health Alliance's experience implementing electronic prescribing of controlled substances with Epic and Imprivata. Finally, it summarizes the results of Delaware's pilot program, which provided at-home drug deactivation systems to specific pharmacies to promote safe disposal of unused prescription drugs.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
This document provides a summary of a presentation on the risks of medical marijuana and marijuana legalization. It begins with disclosures from the presenters and outlines six learning objectives. It then discusses concerns that marijuana is addictive, especially for those who start using it early, and impacts adolescent brain development. The document notes the lack of evidence that marijuana is effective for the conditions it is claimed to treat. It also discusses the risks of increased diversion of marijuana to youth and greater social acceptance of marijuana use negatively impacting public health. The document concludes with messages on how to discuss these issues with the public.
This document summarizes a presentation on engaging physicians in prevention efforts to address the opioid epidemic. It was presented by Yngvild Olsen and included the following key points:
1. Multiple policies like PDMPs, medication-assisted treatment, and naloxone access need to work together to reduce opioid misuse and overdoses.
2. Programs that educate physicians about prescription drug abuse and its link to heroin, and engage them in prevention, screening, and treatment can help address the epidemic.
3. Expanding access to evidence-based treatment with medications like buprenorphine and naloxone, combined with behavioral therapies, can help manage opioid addiction as a chronic disease
Web rx16 prev_tues_200_1_bretthaude-mueller_2scott_3debenedittis_4cairnes copyOPUNITE
This presentation covered multi-media prevention strategies for issues like prescription drug overdoses. It discussed the CDC's digital Rx drug prevention campaign, best practices for digital messaging, and programs using expectancy challenge theory and media literacy education in schools. Presenters included representatives from the CDC, Media Literacy for Prevention, and the Hanley Center Foundation who discussed their work developing and implementing digital communications and single-session prevention programs.
Revised order rx16 pdmp wed_1115_1_eadie_2reilly_3hallvik_4hildebranOPUNITE
This document summarizes a presentation on a study examining how prescriber registration and use of a prescription drug monitoring program (PDMP) in Oregon impacted opioid prescribing patterns and patient outcomes. The study found that statewide opioid prescribing generally decreased over time, but prescribers who registered for the PDMP prescribed more after registering, especially those who used the PDMP most frequently. In contrast, prescribers who did not register prescribed less. Patients whose providers were all registered had lower overdose rates than those with some registered and some non-registered providers. The conclusions were that PDMPs may need refinements like mandatory use to optimize their impact on prescribing and outcomes.
Rx16 federal tues_1115_1_fretwell_2gabbert-wilkebrownOPUNITE
This document summarizes a presentation on state and community-level programs for preventing prescription drug misuse and expanding treatment options like medication-assisted treatment. Speakers from Georgia and Iowa discussed their strategies for engaging stakeholders, implementing prevention initiatives in targeted communities, leveraging funding sources, and addressing challenges in data and addressing disparities. Iowa described their efforts to expand access to medication-assisted treatment for opioid use disorders through a new grant, including challenges implementing changes quickly.
This document summarizes a panel discussion on improving utilization of prescription drug monitoring programs (PDMPs). The panel will discuss current practices for interstate sharing of PDMP data, strategies for integrating PDMP data into healthcare records, and lessons from Washington state's program providing organizations access to PDMP data. The goal is to identify best practices that can be implemented in other states to increase interoperability and utilization of PDMP data.
This document summarizes a presentation on state and federal responses to the opioid epidemic. It discusses innovations from the Kentucky Attorney General including legislative measures targeting pill mills and heroin, programs to expand treatment and recovery, and education initiatives. It also describes the federal response through the Organized Crime Drug Enforcement Task Force (OCDETF), including their national heroin initiative targeting criminal organizations trafficking illegal opioids and heroin, and partnerships with other agencies to address public health and public safety aspects of the epidemic. The presentation outlines strategies at both state and federal levels aimed at improving access to treatment while also enforcing penalties on dealers through investigation and prosecution efforts.
Web only rx16 pdmp-tues_330_1_kreiner_2ringwalt-schiroOPUNITE
This document discusses three projects in North Carolina aimed at reducing harm from prescription drug abuse: 1) Identifying prescribers who prescribe very high levels of controlled substances using PDMP data and algorithms, in partnership with state agencies and the medical board. 2) Identifying prescribers with multiple patients who died from opioid-related overdoses. 3) Providing immediate feedback to prescribers on high-risk patients through electronic health records integrated with PDMP data, in partnership with health systems. The goals are to develop valid methods to identify problematic prescribing patterns using multiple data sources and address technical and policy hurdles to information sharing.
The panel discussion focused on how workers' compensation formularies can reduce opioid prescriptions. Formularies in states like Texas, Ohio, Oklahoma, and Washington were examined. The panel identified best practices for designing and implementing an effective formulary, and discussed stakeholders affected by formularies. Key factors in Texas' successful formulary were identified, as were lessons that can be learned from other states' experiences. The discussion addressed challenges like treating chronic pain if opioids are prescribed less and managing "legacy claims."
This document summarizes presentations from public health officials in North Carolina and Northern Kentucky on community responses to the heroin epidemic. Key points include:
- Officials from North Carolina and Northern Kentucky outlined programs and partnerships implemented in their regions to address rising rates of opioid and heroin abuse, including treatment programs, harm reduction strategies, legislation, and education initiatives.
- Data presented showed increasing rates of overdose deaths, neonatal abstinence syndrome, and infectious diseases associated with intravenous drug use such as hepatitis C in Northern Kentucky.
- Community leaders and advocates in Northern Kentucky have worked to raise awareness, pass legislation to expand access to treatment, and establish prevention and support networks to address the heroin epidemic impacting the region.
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
This document summarizes a presentation on advances in treating chronic pain and addiction. It includes:
- Presenters from PRIUM, American Airlines, and the Treatment Research Institute
- Learning objectives around chronic pain, psychosocial issues, Medicaid requirements for the ASAM Criteria, and implementing the criteria
- Disclosures from presenters about relevant relationships
- Overview of topics like the bidirectional relationship between physical and mental health, impacts of adverse childhood experiences, and the influence of stigma on substance use treatment
- American Airlines' workers compensation program which saw a 40% reduction in claims and lower pharmacy costs and disability after redesigning their approach to focus on early intervention and additional resources for employees with chronic
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
8 pharmacy track pharmacists working with local coalitions and pdm psOPUNITE
This document summarizes a presentation on pharmacists working with local coalitions and prescription drug monitoring programs (PDMPs). It discusses Nicole O'Kane presenting on how pharmacists can utilize PDMPs to screen for safety concerns and optimize patient care. It also discusses Kristina Clark and Christina Merino presenting on how a local coalition in Coffee County, TN engaged pharmacists and other stakeholders to reduce prescription drug abuse through education, monitoring, and evaluation.
This document discusses prescriber viewpoints on how mandating prescription drug monitoring program (PDMP) compliance is working. It provides an overview of presentations from three physicians on their experiences with PDMP mandates in Kentucky, West Virginia, and New York. The physicians evaluate the impact of mandates requiring prescribers to check the PDMP before prescribing opioids. They describe changes in prescribing patterns, attitudes towards the mandates, and recommendations for other states.
E-Prescribing Controlled Substances: Opportunities and Experiences - May 2014...Forward360 LLC
Electronic prescribing of controlled substances (EPCS) provides opportunities to improve safety and reduce fraud compared to paper prescriptions. EPCS is now legal in all but two states, though adoption has been limited due to lack of awareness, competing IT priorities, and geographic disparities between enabled pharmacies and providers. Experiences from providers and pharmacies already using EPCS show benefits like increased accountability, accuracy, and reduced costs. Widespread adoption could save up to $700 million annually through improved medication management.
This document summarizes a presentation on linking and mapping prescription drug monitoring program (PDMP) data. It discusses the benefits of linking PDMP data to clinical data, including improving patient safety, evaluating prescribing decisions, and assessing the impact of PDMP interventions. It describes challenges with linking data, such as obtaining consent and negotiating data use agreements. It also discusses Washington State's MAPPING OPIOID AND OTHER DRUG ISSUES (MOODI) tool, which integrates PDMP data with other databases to map and target treatment and overdose prevention efforts at the community level.
Rx15 ea tues_330_1_lovedale_2holton_3varney-edwardsOPUNITE
The document summarizes a presentation on collaboration, coordination, and data to address prescription drug abuse at the state level. It discusses Tennessee's Prescription for Success initiative, which brought together multiple state agencies under the Public Safety Subcabinet to develop a coordinated action plan. The plan focused on three key initiatives: reducing violent crime, addressing repeat offenders, and creating an environment for job growth. One outcome was a law requiring prescribers and dispensers to use the state's prescription drug monitoring program to curb doctor shopping and misuse. The initiative emphasizes cross-agency collaboration and using data to develop tailored community responses and mobilize resources to combat prescription drug abuse.
This document describes the Prescription Behavior Surveillance System (PBSS), which uses de-identified prescription drug monitoring program (PDMP) data from multiple states to conduct public health surveillance and evaluate initiatives aimed at influencing prescriber behavior. The PBSS is guided by a committee including federal and state partners and aims to identify emerging trends, changes in prescribing patterns, and indicators of risk. It provides regular surveillance reports and measures of appropriate/inappropriate prescribing. The PBSS also evaluates selected state prescriber initiatives and their evidence base. Examples of surveillance data and potential additional applications are provided.
PDMP: Prescription Behavior Surveillance System - The Value and Applications of De-identified PDMP Data in Public Health Surveillance - Dr. Peter Kreiner and Mike Small
This document summarizes a presentation on combining prescription drug monitoring program (PDMP) data with other data sources to combat prescription drug abuse. The presentation includes three speakers and a moderator. It outlines learning objectives around identifying reasons and methods for combining PDMP data, evaluating a study combining laboratory and PDMP data, and describing a San Diego project combining PDMP and medical examiner data. The presentation then reviews a case study approach and nationwide study results showing the effectiveness of combining these data sources to identify high-risk patients. It also summarizes findings from a 2013 analysis in San Diego that linked PDMP and medical examiner prescription drug death records.
This document summarizes a presentation on combining PDMP and other data to combat prescription drug abuse. It discusses the problems with isolated pharmacy and laboratory databases and outlines two patient case studies. It then describes a nationwide study that evaluated combining laboratory and PDMP data to identify patients not taking medications responsibly, finding inconsistent test results in 70.9% of high-risk patients. Finally, it summarizes a San Diego collaborative project that combined PDMP and medical examiner data on 254 prescription-related deaths in 2013.
This document summarizes a presentation on combining prescription drug monitoring program (PDMP) data with other data sources to combat prescription drug abuse. The presentation includes three speakers and a moderator. It outlines learning objectives around identifying reasons and methods for combining PDMP and other data, evaluating a study combining laboratory and PDMP data, and describing a San Diego project combining PDMP and medical examiner data. The presentation then reviews a case study approach combining PDMP and toxicology results, and evaluates a nationwide study showing a high degree of inconsistent test results when combining pharmacy and laboratory data on high-risk patients. It concludes that combining these data sources is effective for identifying high-risk opioid users.
This document discusses six things that medical practices must know about quality to remain viable. It notes that value-based purchasing is now required by law, with value determined by both cost and quality. Quality will be measured using PQRS measures. 2013 is a pivotal year for reporting to avoid penalties in 2015. Electronic quality measures are the future of reporting. Practices should use population management and rapid cycle improvement to close performance gaps. They should take advantage of opportunities to increase revenue through expanded Medicare coverage and programs that incentivize quality.
This document outlines a proposal for a new generation of Prescription Monitoring Programs (PMPs) to more proactively address the prescription drug abuse epidemic. Key aspects of the proposal include standardizing and speeding up data collection; identifying who picks up prescriptions; integrating with electronic prescribing; improving data quality; linking prescription records; providing online access to reports and automated alerts; and performing analyses to identify problematic prescribing patterns to target interventions. The goal is to move PMPs from a reactive to proactive role in confronting drug abuse and diversion.
This document summarizes a medication adherence platform called Medisafe. It discusses how Medisafe addresses the major causes of non-adherence through personalized medication management. The document also provides data on medication non-adherence costs and statistics, an overview of Medisafe's features and user growth, clinical studies showing improved adherence, and strategies for expanding the platform to involve providers and payers. It analyzes the competitive landscape and outlines how Medisafe differentiates itself as the market leader in medication management.
Provider directory accuracy is critical to ensuring consumers get the care they need from the right doctors. The challenge is the rate at which provider data changes and getting that information into the hands of members. Now regulatory bodies are demanding health insurers put processes in place that ensure the information they collect and publish to their member populations is current and complete. Updating mandatory data fields like address, acceptance of new patients, specialty, languages spoken and more can become overwhelming for a health plan – putting a strain on resources. LexisNexis explores where regulations stand, the nature of provider data and why maintaining it is a challenge, and a proven approach to managing your provider data and directories.
Understand how the HSCIC are continuing to improve data quality:
- Good quality data is, and has always been, a key part of improving services.
- It supports informed decision making.
- Those decisions can affect a single individual or the whole of the health and social care system.
This presentation was delivered at EHI Live 2013.
The document discusses challenges in medication reconciliation and potential benefits of using IT-enabled solutions. It describes research from McGill University that developed an electronic medication reconciliation application called RightRx, which integrated with the Quebec health insurance database to retrieve patient medication histories and automate communication of changes to community providers. The research found that automated retrieval of community medication lists and integration with computerized provider order entry can reduce medication discrepancies and potential adverse drug events.
Marketing proposal to Hartford HealthcareArchit Patel
The presentation is a brief description to the proposed marketing strategy for the Hartford healthcare specifically targeting on the New Health Enhancement Program proposed for Connecticut state employees.
Similar to Rx16 pdmp tues_200_1_o_neill_2carter_3small_armagan (20)
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
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This document discusses a presentation on pharmacy burglary, robbery, and diversion of prescription drugs. The presentation covers trends in prescription drug diversion, particularly those involving robbery and burglary of pharmacies. It identifies preventative measures to enhance pharmacy security and safety. Strategies to reduce pharmacy crimes are outlined. The offender perspective is examined based on interviews with convicted offenders. Routine activities theory is discussed as relating to suitable targets, capable guardians, and motivated offenders. Partnerships between regulatory agencies and law enforcement are emphasized as key to prevention efforts.
This document discusses drug court models and the role of law enforcement in drug courts. It begins with introductions from presenters and outlines learning objectives about explaining drug court operations and benefits, how law enforcement can utilize drug courts, and identifying best practices. The following sections provide details on drug court models, including how they integrate treatment into the justice system using a non-adversarial approach. Key components of drug courts are outlined, and presenters discuss issues like prescription drug and heroin abuse as well as outcomes from drug courts in reducing recidivism and saving money. Law enforcement can play roles in prevention, addressing domestic violence, and targeting the right populations for drug court involvement through assessment.
This document summarizes presentations from two communities - Huntington, WV and Camden County, NJ - on their responses to heroin crises. It outlines programs implemented in Huntington, including a harm reduction program, centralized information system, and drug court expansion. It also discusses the region's history with prescription drug abuse and rise in heroin and associated issues like hepatitis and neonatal abstinence syndrome. Long-term strategies proposed include expanding treatment services, promoting career opportunities for those in recovery, and preventing relapse through environmental design changes.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
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This document summarizes a presentation about the Handle with Care program, which aims to help children who have been exposed to trauma. The presentation discusses how drug abuse and violence impact children, showing statistics on drug seizures and crimes in certain areas. It then describes the Handle with Care program, where law enforcement notifies schools of children who were exposed to a traumatic event so the school can provide trauma-informed support. School interventions discussed include therapy dogs, academic accommodations, and on-site therapy. The presenters emphasize that Handle with Care aims to help children succeed in school by providing trauma-sensitive support.
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
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2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
1. New Developments in PDMPs:
California, Colorado and Minnesota
Presenters:
• Mark R. O’Neill, RPh, Program Manager, Colorado Prescription Drug
Monitoring Program
• Barbara A. Carter, PMP Manager, Minnesota Board of Pharmacy,
Prescription Monitoring Program
• Tina Farales, Department of Justice Administrator, Prescription Drug
Monitoring Program, California Department of Justice
• Artin Armagan, PhD, Manager, Advanced Analytics Lab, SAS Institute
PDMP Track
Moderator: John L. Eadie, Coordinator, Public Health and Prescription Drug
Monitoring Program Project, National Emerging Threat Initiative, National HIDTA
Assistance Center, and Member, Rx and Heroin Summit National Advisory Board
2. Disclosures
• Barbara A. Carter; Tina Farales; Mark R. O’Neill, RPh;
and John L. Eadie have disclosed no relevant, real, or
apparent personal or professional financial
relationships with proprietary entities that produce
healthcare goods and services.
• Artin Armagan, PhD – Ownership interest: Walmart
(spouse)
3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
4. Learning Objectives
1. Express the value of PDMPs as healthcare
tools.
2. Describe PDMP enhancements that improve
data integrity and streamline retrieval and
viewing of PDMP searches and reports.
3. Identify the features and benefits of
California’s upgraded PDMP, CURES 2.0.
4. Provide accurate and appropriate counsel as
part of the treatment team.
5. New Developments in PDMPs:
Colorado
Mark R. O’Neill, RPh
Program Manager
Colorado Prescription Drug
Monitoring Program
6. Focus on Value: A map of Colorado’s rising drug-
related deaths between 2002 and 2014.
Representation of the need for PDMP programs
in the United States.
7. Colorado Drug Overdose Death Rate 2002
“Colorado Drug Death Rate Tops U.S. Average,” Colorado Health Institute, Feb. 2016
8. Colorado Drug Overdose Death Rate 2014
“Colorado Drug Death Rate Tops U.S. Average,” Colorado Health Institute, Feb. 2016
9. Colorado PDMP: An overview
Began 2007. 6 prescribing Boards /
Pharmacy. 2 person staff.
3rd Party vendor. ~ $175,000 / year.
Funded by prescriber fees.
Colorado Population: 5.5 million
Over 2.6 million patient specific queries in
2015
10. Enhancements: PDMP as a Healthcare Tool
Legislative Update 2014
Mandatory registration (not mandatory use) of all DEA
registered prescribers
Daily reporting by pharmacies to increase reliability and
trust of data
Delegated authority for increased use and access for
prescribers and pharmacists – up to 3 trained delegates
Access granted to Colorado Department of Public Health
and Environment
12. Tackling Doctor Shopping - Push Notices
Obtaining controlled substances from multiple sources in
potentially dangerous quantities.
Prescribers and pharmacists can use the PDMP to stop
“doctor shopping.”
Push Notice letters are sent out to prescribers and
pharmacies monthly.
Push Notices are often a “reality check” for prescribers
and pharmacists
13.
14. Streamlined Retrieval of Data
Automated Access:
Single log-on access to patients’ PDMP files
Inclusion of “Rxcheck”
Allows for efficient, reliable and secure access.
Currently used at two practice sites in Colorado: one
major chain pharmacy and one federal facility.
15. Streamlined Retrieval of Data
Integration of Electronic Health Records through the
Harold Rogers PDMP Grant for Practitioner and Research
Partnerships
5 major Emergency Departments at Colorado hospitals
16. Colorado: Outreach and Education
Outreach to Colorado – Speakers Bureau offers ongoing
PDMP information.
Consortium for the Prevention of Prescription Drug Abuse:
Created as “Task Force” for continued improvement of
PDMP.
New PDMP dedicated website
Training webinars
YouTube videos
Production of PDMP brochure
17. New Developments in PDMPs:
Minnesota
Barbara A. Carter
PMP Manager
Minnesota Board of Pharmacy
18. Disclosure Statement
• Barbara A. Carter, has disclosed no relevant,
real or apparent personal or professional
financial relationships with proprietary
entities that produce health care good and
services.
19. Learning Objectives
• Express the value of PDMPs as healthcare
tools.
• Describe PDMP enhancements that improve
data integrity and streamline retrieval and
viewing of PDMP searches and reports.
• Identify the features and benefits of
California’s upgraded PDMP, CURES 2.0.
• Provide accurate and appropriate counsel as
part of the treatment team.
20. DATA REPORTING & DATA INTEGRITY:
THE PATH TO IMPROVEMENT
Barbara A Carter, PMP Manager, Minnesota Board of Pharmacy
21. Identifying the Issues
• Compliance in Reporting
– Are all dispensers reporting?
– How often are they reporting?
• Data Quality
– How accurate is the data?
– Are there missing records?
22. Facts and Figures
2010
• 1,700 licensed
pharmacies
• 6.6M prescription records
(CS II-IV)
2015
• 2,000 licensed
pharmacies
• 8M prescription records
(CS II-V)
23. Are all dispensers reporting?
• Honor System
– Unmet Expectations
• Unique Pharmacy Identifier
– Pharmacy DEA#
• Match with MN pharmacy license #
• Monthly Compliance
– 1st notice
– 2nd notice ($10,000 fine)
– Phone Call
– Complaint filed
24. How often are they reporting?
• Daily reporting required
– By procedure not statute
• Inadequate Reporting
– Definition
• Less than 20 reports monthly
• Identify manageable threshold
– 10 reports
– 18 reports
25. DATA QUALITY
• Who uploads the data?
– Pharmacy staff
– Corporate office
– External vendor
• How are errors communicated and to whom?
– Error reports
• Email
• Fax
– Data uploader
26. Errors impacting end user
• Minor
– Days supply invalid (>180 days)
– Refill code is not a #
• Serious
– Invalid prescriber DEA#
– Invalid NDC #
• Fatal
– Blank prescriber DEA#
– Blank DOB
27. Current initiative
• Blast communication-2 months in advance
– Uploader and PIC
• Error correction within 7 days receipt of edit report
• Establish relationship with data uploader
• Auditing Begins
– Weekly error summary report
• Identify worst offenders
– Errors that impact end user
• Allow 7 days to pass then audit for error resolution
28. Determining Compliance
• Errors resolved within 7 days
• Outstanding errors
– Phone call to Pharmacist in Charge (PIC)
• Secure email with prescription details
• Ongoing collaboration with PIC, uploader and PMP
vendor
– Complaint filed with Board
29. Outcomes
• Compliance in reporting improved
• Frequency of reporting improved
• Improvement in data quality
• Relationships improved
30. Lessons Learned
• Communication is Critical
– PMP and Dispenser
– Dispenser and their Vendor
• Start Out Small
• Hidden Issues uncovered
• Dedicated Resources
• Work in Progress
31. Next Steps
• Recognize “gold star” performance
• Update contact lists
• Update error report communication
preference
• Create tutorials-how to’s for data providers
• Increase frequency of communications
• Educate, educate, educate
34. Mike Small has disclosed no relevant, real or
apparent personal or professional financial
relationships with proprietary entities that
produce health care goods and services.
Artin Armagan has disclosed that his spouse is
employed as a pharmacist by Duke Raleigh
Hospital and Walmart Pharmacy.
35. New Developments in PDMPs
California’s CURES 2.0
Learning Objective:
Identify the features and benefits of California’s upgraded
PDMP, CURES 2.0.
36. California Health and Safety Code section § 11165. (a)
To assist health care practitioners in their efforts to ensure
appropriate prescribing, ordering, administering, furnishing, and
dispensing of controlled substances, law enforcement and
regulatory agencies in their efforts to control the diversion and
resultant abuse of Schedule II, Schedule III, and Schedule IV
controlled substances, and for statistical analysis, education, and
research, the Department of Justice shall . . . maintain the
Controlled Substance Utilization Review and Evaluation System
(CURES)…Review and Evaluation System (CURES)…
37. The Iatrogenically Addicted Patient and the
Doctor Shopper
~
Information Delivery
~
Support the Public Health Sector
~
The Public Needs to Know
~
Analytics
38. Automated Registration
California clinical users are provided a fully automated
registration process.
Delegation Authority
Prescribers and dispensers can easily assign delegates who can
initiate CURES 2.0 patient inquiries on their behalf.
Compact Flagging
Prescribers can easily notate their patients with treatment
exclusivity compacts, forewarning other providers that additional
prescribing to these patients can be potentially counter-
productive to their existing treatment regimen.
CURES 2.0 User Features
39. Peer-to-Peer Communication
Prescribers and dispensers can instigate alert messages to fellow
doctors and pharmacists about mutual patients of concern.
Patient Safety Messaging
Prescribers are alerted daily with information regarding their
patients who reach various prescribing thresholds.
CURES 2.0 User Features
40. CURES 2.0 systematically de-duplicates and de-identifies
county and statewide data sets for County Health Officers and
researchers.
Quarterly and annual de-identified data sets are produced for
County Health Officers.
This data enables counties to calculate current rates of
prescriptions, examine variations within the state, and track
the impact of safe prescribing initiatives.
De-Duplicated / De-Identified Data
41. 1. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who are Currently Prescribed More than 100 Morphine
Milligram Equivalency Per Day
2. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who Have Obtained Prescriptions from 6 or More
Prescribers or 6 or More Pharmacies During Last 6 Months
3. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who Are Currently Prescribed More than 40 MMEs
Methadone Daily
4. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who Are Currently Prescribed Opioids More Than 90
Consecutive Days
5. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who Are Currently Prescribed Both Benzodiazepines
and Opioids
Patient Safety Messaging
42.
43.
44.
45.
46. 1 Total Number of Prescriptions for Opioid Drugs by Month, by
State, County and Zip Code
2 Total Number of Prescriptions for Opioid Drugs by Calendar Year,
by State, County and Zip Code
3 Total Number of Unique Patients Prescribed Opioids by Month,
by State, County and Zip Code
4 Total Number of Unique Patients Prescribed Opioids by Calendar
Year, by State, County and Zip Code
5 Number of Opioid Pills Prescribed by Month, by State,
County and Zip Code
6 Number of Opioid Pills Prescribed by Calendar Year, by State,
County and Zip Code
7 Median Number of Opioid Pills Per Prescription by Month, by
State, County and Zip Code
Public Reports
47. 8 Median Number of Opioid Pills Per Prescribed by Calendar Year, by
State, County and Zip Code
9 Number of Patients Receiving Opioid Prescriptions by Month, by
State, County and Zip Code, by Age as Follows: ≤ 14; 15-24; 25-44;
45-64; ≥65
10 Number of Patients Receiving Opioid Prescriptions by Calendar Year,
by State, County and Zip Code, by Age as Follows: ≤ 14; 15-24;
25-44; 45-64; ≥65
11 Number of Opioid Pills and Benzodiasepine Pills Prescribed to the
Same Patient by Month, by State, County and Zip Code
12 Number of Opioid Pills and Benzodiasepine Pills Prescribed to the
Same Patient by Calendar Year, by State, County and Zip Code
Public Reports
48. 13 Number of Patients, by Month, Prescribed Both Opioids and
Benzodiasepine, by State, County and Zip Code
14 Number of Patients, by Year, Prescribed Both Opioids and
Benzodiasepine Within Any 30 Day Window, by State, County and Zip
Code
15 Total Morphine Milligram and Morphine Kilogram Equivalents
Prescribed by Month, by State, County and Zip Code
16 Total Morphine Milligram and Morphine Kilogram Equivalents
Prescribed by Calendar Year, by State, County and Zip Code
17 Morphine Milligram and Morphine Kilogram Equivalents Prescribed by
Month, by State, County and Zip Code for: Oxycodone, Hydrocodone,
Morphine, Methadone, Hydromorphone, Buprenorphine, Fentanyl,
Oxymorphone, Codeine, Levorphanol, and Zohydro
Public Reports
49. 18 Morphine Milligram and Morphine Kilogram Equivalents Prescribed by
Calendar Year, by State, County and Zip Code for: Oxycodone,
Hydrocodone, Morphine, Methadone, Hydromorphone,
Buprenorphine, Fentanyl, Oxymorphone, Codeine,
Levorphanol, and Zohydro
19 Number of Very Frequent Opioid Prescribers (580+ Opioid Rx/Yr),
Frequent Prescribers (50-579 Opioid Rx/Yr), Occasional Prescribers
(8-49 Opioid Rx/Yr), and Rare Prescribers (1-7 Opioid Rx/Yr), by State, by
State, County and Zip Code
20 Number of Very Frequent Schedule II Drug Prescribers (580+ Sked II
Rx/Yr), Frequent Prescribers (50-579 Sked II Rx/Yr), Occasional
Prescribers (8-49 Sked II Rx/Yr), and Rare Prescribers (1-7 Sked II Rx/Yr),
by State, County and Zip Code
21 Total Number of Prescriptions for all Schedule II Drugs by Month, by
State, County and Zip Code
Public Reports
50. 21 Total Number of Prescriptions for all Schedule II Drugs by Month, by
State, County and Zip Code
22 Total Number of Prescriptions for all Schedule II Drugs by
Calendar Year, by State, County and Zip Code
23 Total Number of Prescriptions for Schedules II, III, and IV Drugs, by
Schedule and Total, by Month, by State, County and Zip Code
24 Total Number of Prescriptions for Schedules II, III, and IV Drugs, by
Schedule and Total, by Calendar Year, by State, County and Zip Code
25 Total Number Patients Receiving Schedule II, III and IV Drug
Prescriptions, by Month, by State, County and Zip Code
26 Total Number Patients Receiving Schedule II, III and IV Drug
Prescriptions, by Calendar Year, by State, County and Zip Code
Public Reports
51. 27 Median Number of Pills Per Prescription for Schedules II, III, and IV
Drugs by Month, by State, County and Zip Code
28 Median Number of Pills Prescribed for Schedules II, III, and IV
Drugs by Calendar Year, by State, County and Zip Code
29 Median Number of Pills Per Prescription for Schedule II Drugs by
Month, by State, County and Zip Code
30 Median Number of Pills Prescribed for Schedule II Drugs by
Calendar Year, by State, County and Zip Code
31 Median Pills , by Month, Per Schedule II, III, or IV Prescription by
Age as follows: ≤ 14; 15-24; 25-44; 45-64; ≥65
32 Median Pills , by Year, Per Schedule II, III, or IV Prescription
by Age as follows: ≤ 14; 15-24; 25-44; 45-64; ≥65
Public Reports
52. 33 Number of Prescriber and Dispenser Registrants, by Month, by
State, County and Zip Code
34 Number of Prescriber and Dispenser Registrants, by Year, by State,
County and Zip Code
35 Number of Patients Who Obtained 4 or More Schedule II, III, or IV
Prescriptions from 4 or More Dispensers During Prior 12 months, by
State, County and Zip Code
36 Number of Patients Who Obtained 4 or More Schedule II, III, or IV
Prescriptions from 4 or More Dispensers During the Calendar Year,
by State, County and Zip Code
37 Number of Patients with Same Prescription Drug from 3 or More
Prescribers, by Month, by State, County and Zip Code
Public Reports
53. 38 Number of Patients with Same Prescription Drug from 3 or More
Prescribers, by Calendar Year, by State, County and Zip Code
39 Number of CURES Inquiries by Prescribers, by Month, by State,
County, and Zip Code
40 Number of CURES Inquiries by Prescribers, by Year, by State, County,
and Zip Code
41 Number of CURES Inquiries by Dispensers, by Month, by State,
County, and Zip Code
42 Number of CURES Inquiries by Dispensers, by Year, by State, County,
and Zip Code
43 Numbers of Prescribers Prescribing Opioids and Benzodiazepines
Concurrently to a Patient, by Month, by State, County, and
Zip Code
Public Reports
54. 44 Numbers of Prescribers Prescribing Opioids and Benzodiazepines
Concurrently to a Patient, by Year, by State, County, and Zip Code
45 Number of Patients Currently Prescribed More than 100
Morphine Milligram Equivalency Per Day, by Month, by State,
County, and Zip Code
46 Number of Patients Currently Prescribed More than
100 Morphine Milligram Equivalency Per Day, by Year,
by State, County, and Zip Code
47 Number of Patients Who Are Currently Prescribed More than 40
Milligrams Methadone Daily, by Month, by State, County, and
Zip Code
48 Number of Patients Who Are Currently Prescribed More than 40
Milligrams Methadone Daily, by Year, by State, County, and
Zip Code
Public Reports
56. ENTITY RESOLUTION
John Doe
01/01/70
456 HARRISON AVE
CARY, NC 27513John Doe
01/01/70
123 HARRISON AVE
CARY, NC 27513
John Doe
01/01/70
789 HARRISON AVE
CARY, NC 27511
Johnnie Doe
01/01/70
123 HARISON AVE
CARY, NC 27511
ONE ENTITY
57. PATIENT SCENARIOS
1. Rx Recipients Who are Currently Prescribed More than 100
Morphine Milligram Equivalency Per Day
2. Rx Recipients Who Have Obtained Prescriptions from 6 or More
Prescribers or 6 or More Pharmacies During Last 6 Months
3. Rx Recipients Who Are Currently Prescribed More than 40 MMEs
Methadone Daily
4. Rx Recipients Who Are Currently Prescribed Opioids More Than 90
Consecutive Days
5. Rx Recipients Who Are Currently Prescribed Both Benzodiazepines
and Opioids
60. ALERTS
• Patient Name
• Patient DOB
• Patient Address
• Patient City
• Patient Zip Code
• # of Anomalous
Scenarios
• Triggered Scenarios
61. DE-IDENTIFIED DATA
Anonymized Patient ID
Anonymized Prescriber ID
Anonymized Pharmacy ID
Patient Birth Year
Patient Gender
Patient Zip Code
Patient County
Patient State
Prescriber Zip Code
Prescriber County
Prescriber State
Pharmacy Zip Code
Pharmacy County
Pharmacy State
Product Name
NDC
Drug Form
Strength
Quantity
Days Supply
Date Filled
Refill Number
Payment Code
Prescriber Specialty
Prescriber Board Certification
Indicator
• Personally identifying information redacted.
• Anonymized patient IDs maintained to be consistent
from report to report.
• Generated quarterly and annually for each county and
the entire state.
63. New Developments in PDMPs:
California, Colorado and Minnesota
Presenters:
• Mark R. O’Neill, RPh, Program Manager, Colorado Prescription Drug
Monitoring Program
• Barbara A. Carter, PMP Manager, Minnesota Board of Pharmacy,
Prescription Monitoring Program
• Tina Farales, Department of Justice Administrator, Prescription Drug
Monitoring Program, California Department of Justice
• Artin Armagan, PhD, Manager, Advanced Analytics Lab, SAS Institute
PDMP Track
Moderator: John L. Eadie, Coordinator, Public Health and Prescription Drug
Monitoring Program Project, National Emerging Threat Initiative, National HIDTA
Assistance Center, and Member, Rx and Heroin Summit National Advisory Board
Editor's Notes
As you heard from Mark several improvements in CO have been made in the accessibility and use of the data. As we continue to encourage use of PMPs it is critical that A) We get all of the prescription information that we should be getting and B) That the data is accurate. Like many PMPs our program staff get calls from prescribers and pharmacists when there are prescriptions missing from the database, there is no prescriber name in the record, they cant find a patient and so on. Who would have thought that data received would not be perfect?
Determining compliance in reporting and the integrity of the data reported has been a challenge for some PMPs. In MN we recognized early on that this would be a huge undertaking and knew that we couldn’t deal with it all at once.
As with any challenge we needed to first break down the issues. Broken down in to two areas seemed to be much more manageable. We needed to know if all of the dispensers who should be reporting were and how often were they reporting
[NEXT] Secondly we needed to know how accurate was the data they were reporting and were there any missing records or files.
Before I continue I just want to lay the groundwork for what we would be dealing with.
In 2010-when the PMP was first implemented there were approximately 1700 MN licensed pharmacies and by the end of that calendar year we had collected close to 6.6 million prescription records. Fast forward to 2015 and now we are dealing with more than 2,000 pharmacies and 8 million prescriptions. From here on out I will use pharmacy and dispenser interchangeably.
In the beginning, we relied heavily on dispensers, most of which are pharmacies, to comply with the new law based on the honor system. But we quickly learned that it wasn’t quite working as we had planned. Our contracted PMP vendor provided a monthly report showing which dispensers were reporting data, but the number of reporting pharmacies didn’t seem to come close to what we expected.
[NEXT} Because pharmacies reported using their DEA registration number and not their MN license number it was very difficult to match those reporting with those not reporting. So the first thing we had to do was request that each and every pharmacy licensed by MN, who was not exempted from reporting, send us their DEA# and then capture it in their pharmacy license record. At that time a very manual and time consuming process, but we did it. Finally in 2011 we began providing our PMP vendor a current monthly data file of all MN licensed pharmacies, which included their DEA# to be used for matching. The reports returned show all who reported on one tab, including the number of data uploads and those who did not report data for the given month on another.
[NEXT} Those identified as not reporting are notified by mail of their non-compliance and are required to commence reporting immediately. If necessary a second letter is sent, this time with a stronger message which included the possibility of up to a $10,000 file (imposed by the Board, not the PMP) for non-compliance. Continued failure to comply results in a phone call and if needed a complaint is filed with the Board. Very few complaints are filed as that reference to the $10,000 fine seemed to make an impact.
But just reporting doesn’t satisfy the requirements. Our expectation is that the pharmacy report either at the end of the business day or the next day. Procedures established by the PMP require daily reporting of prescriptions dispensed. Getting the data is important, but getting it in a timely manner is critical to the PDMP being a valuable healthcare tool. The number of file uploads is included in the monthly compliance reports and is used to identify how often files are being uploaded. Because we are located in the Board of Pharmacy, PMP staff have access to information in the pharmacy license record such as their business days and hours, which has proven to be very useful in determining how many uploads in a month we should be expecting from a specific pharmacy. Therefore setting a more realistic threshold. Taking into account holidays and weekends, we defined inadequate reporting as less than 20 reports from a pharmacy during a given month. We started with the biggest offenders and therefore set our initial threshold a bit lower. Those with less than 10 reports were considered non-compliant and the pharmacy was notified. As a result of our efforts we recently increased the threshold to 18 reports a months.
Notification to pharmacies and process for gaining compliance is similar to reporting compliance process in which notifications are sent and if compliance is not met after the second notice, a phone call is made and if no results a complaint is filed with the Board. Again, very few dispensers have been turned over to the board for further consideration.
The next phase of our initiative was to deal with data quality. In this day and age of technology one might think that reporting is done automatically without human intervention. That is not always the case. Depending on the pharmacy the data uploader might be a pharmacy staff person, such as the pharmacist in charge or a technician or it could be done at the corporate level. There are even pharmacy operations software vendors who might provide the data upload service.
When data is submitted to the MN PMP, via our software vendor, the records being submitted, using a set of industry standards, are checked for errors. The MN PMP RxSentry, the application used by MN for ourr data collection and dissemination, automatically generates a report confirming no errors in the batch submitted, or indicating errors. These error reports are sent via email or fax, depending on the data uploaders preference. Since the data uploader can be one of several involved in the prescription records communications are critical to data quality.
In the MN PMP RxSentry system, errors are assigned one of three levels.
Minor, which if not correct have the least impact on the end user.
Such as days supply being greater than 180 days or the code for a refill not being a number.
[NEXT] Serious , which if not corrected do have an impact on the end user who is using the PMP as part of their patient care. Errors such as an invalid prescriber DEA#, will not list a prescriber’s name since the DEA# is not legitimate or an invalid National Drug Code (NDC) which when viewed in a report will provide an n/a for the medication dispensed.
[NEXT] And finally Fatal errors. When a record with a fatal error is submitted, that record will not load into the database, it will be rejected. Two of the most frequent fatal errors are blank prescriber DEA# and Blank date of birth.
In addition, a file containing a percentage of both fatal and serious errors greater than the established threshold will reject as well. Thus even more records that will not be in the database if not corrected.
So how did we start-
We began by establishing an error correction timeline and identifying those errors that we deemed most critical to the end user. Blast communications were sent out 2 months in advance to not only those identified within our system as the “data uploaders” but also the pharmacists in charge at all MN licensed pharmacies, regardless of whether or not they were required to report data. We indicated that our expectation is that errors are corrected within 7 days, all errors including minor errors. We also encouraged them to establish a relationship with each other as we knew that in some cases a PIC really had no knowledge of how their data got to us to begin with. This relationship building really became the key to success.
Once we were confident that we were ready to proceed we began to receive a weekly error summary report, which contained errors from the week prior. The first report contained 695 total errors from 247 different pharmacies. Of the errors we deemed to impact the end user with the greatest severity, 298 errors were identified from 140 pharmacies. Pretty overwhelming-so we already needed to adjust our process. We identified what we are calling the “worst offenders”, those with the most errors that impacted the end users and picked the top two. The errors we focused on were invalid prescriber DEA# and blank prescriber DEA#. We wait until the end of the allowable 7day correction period, and audit their data to determine compliance in corrections.
If it is found that the pharmacy has resolved their errors within 7 days without intervention
[NEXT] we internally, give them a gold star.
We are currently picking the top 2 offenders but we do move down the list until we have identified 2 that have not corrected errors. Currently we estimate it takes on average 1 hour to audit a pharmacy.
[NEXT} If it is determined that the errors have not been fixed, we make a phone call. The PIC is called initially and not the uploader as the responsibility ultimately lies with PIC to submit accurate data. After sometimes a fairly lengthy discussion a secure email containing the prescriptions in questions is sent. Generally we find that most PICs need some assistance in fixing records so we do find ourselves communicating with PIC, Uploader and sometimes our PMP vendor to resolve errors.
[NEXT] If this all fails, and it appears that the pharmacy is blatantly disregarding correcting errors or keeps making promises week after week that they do not keep-a complaint is filed with the Board.
Compliance in reporting rates went from about 87% of pharmacies reporting in 2011 to more than 98% reporting in 2015. Because new pharmacies come on board daily we use the total number of pharmacies licensed at the beginning of the calendar year to measure against.
[NEXT] Frequency of reporting improved and therefore we were able to tighten the monitoring threshold to look for reporting less than 18 days in a month. We have on average 20 pharmacies that doe not meet the threshold. Down from 80 when we first began. This number has become progressively smaller since the inceptions of inadequate reporting because many pharmacies have responded letting us know they are only open one day a week, or month or that they are closed on the weekends
[NEXT] Improved data quality- for example invalid DEAs were removed from the pharmacy’s prescriber dropdown lists so they would not be used again. But most importantly we educated the pharmacies on how the bad data impacts the end user.
[NEXT] We continue to educate PICs in the process of data reporting and what they should be expecting of their uploader. Facilitating the communications between PIC and uploader proved to be well worth the time invested.
All in all we feel that the communications we initially sent and the ongoing communications with PIC and uploaders does have an impact as when auditing we do find that errors are corrected without intervention.
As was previously mentioned, communications is critical to improving both compliance in reporting and the quality of the data being reported. Fostering the relationships between PIC and data uploaders is an ongoing effort.
[NEXT] The process for auditing is very manual at this time, therefore starting out small is best for ones sanity.
[NEXT] We uncovered hidden issues such as pharmacies that were reporting and stopped reporting and didn’t realize they had an internal system issue, the manner in which compounds were being reported was incorrect for all compounds from that pharmacy, and we even found long term care pharmacies dispensing via automated drug distribution systems within the long term care facilities were reporting each time a pill was dispensed out of the machine as a prescription when the law exempted them from reporting that data in the first place.
[NEXT] In order to fully engage in a data quality improvement process we will needed additional dedicated resources. We know that it takes approximately 10-15 hours a week to audit and communicate with just a fraction of those pharmacies who are submitting and not correcting their errors without some level of intervention.
[NEXT] This initiative continues to be a work in progress as we keep finding the need to modify criteria and thresholds, especially after identifying the hidden issues.
So what are our next steps?
[NEXT} Send a notice of recognition to the pharmacy when we identify them as resolving errors without intervention.
[NEXT] Send blast communication to uploaders requesting their current contact info
[NEXT] and ask them to update their preference for receiving reports
[NEXT]Create a short tutorial on how to revise, remove, or submit a record in the MN PMP so that we can shift our focus to address more errors not being corrected
[NEXT] Request space in Board newsletters to provide an update on error resolution and other important PMP information
{NEXT} and finally continue to educate not only on data reporting but data corrections and use of the database