The document outlines a statewide initiative aimed at screening patients seeking narcotics in urgent care facilities to reduce prescription drug abuse. It describes a multi-phase project involving data gathering, software interface design, workflow evaluation, and analysis to identify potential narcotic abusers. The goal is to improve patient care, optimize healthcare resources, and support providers by allowing access to a state narcotics monitoring program.

1. Statewide Screening: Narcotics Seeking Patients at Urgent Care Facilities CIS 512 Trevor Rohm Winter 2009

2. Introduction limited resources busy, and at times overburdened With prescription drug abuse statistics estimating that as much as 10% of the population Visiting multiple facilities is known as “doctor shopping” limited narcotics monitoring program

3. Project Goals Verify Those who require narcotics are not seeking treatment from multiple providers Screening through the state narcotic monitoring program Freeing valuable limited resources Design and implementation will focus on three key aspects: People Policy Processes

4. Attention Areas Phase 1: Information gathering about current numbers of patients to screen Phase 2: Design and implementation of software interface with the state system Phase 3: Workflow evaluation, modifications and implementation Phase 4: Analysis and results

5. Limits Primitive experimental design to apply the intervention and then assess impact. No sampling No pretest No control group A count of the number of suspected narcotic abusers, will serve as our measurement 3 different cities 5 five urgent care facilities Healthcare system Adult only Exclude children Exclude pregnant women Pitfalls Not randomized No control group Single intervention group Clinical providers rotate Different patient populations indigent patients rural community large migrant population urban downtown setting new affluent community They all serve unique populations, however, narcotic seeking patients have been known to frequent all 5 facilities, sometimes all in a single day.

6. Phase 1: Information Gathering Determine the total number of patient visits total number of unique patients the corresponding chief complaints for each visit Count number of patient visits number of unique patients number of visits per patient Correlational study number of times a patient presents to the Urgent Care number of prescriptions (Rx) for narcotics given Data plotted in 2 graphs. One for # of Rx and the other for # of pills. Project implementation and resource allocation

7. Phase 2: Design and Evaluation Current Narcotic Monitoring System Requires pharmacies to upload information for all narcotics prescriptions Once a month Batches may be uploaded online, sent by magnetic tapes, CDs or by paper processes Single aggregate database Project design will include a user-friendly, provider view of the state database develop a real-time web-based system interface for Urgent Care facilities

8. Phase 3: Workflow Changes Necessary to involve the whole healthcare team: registration clerks triage nurses healthcare providers Backup procedures system failure or internet outage Policy so each team member can fulfill their job to capacity Implementation must NOT limit healthcare providers nor interfere with their ability to care for patients Information provided by the state can be used to help the provide care, however, it should never preclude prescribing additional medication if clinically indicated Policy should never impede patient care and should always promote patient safety Administration fully support project

9. Phase 4: Analysis and Results 12 months of data Count of the number of Rxs for narcotics and the number of pills will be determined. A correlational graph will be plotted We will compute the following: percentage of total visits by reported patients the total number of narcotic Rxs provided these patients the total number of pills provided these patients the average number of pills per patient the average number of Rxs per patient the average number of visits per patient average cost per visit (as determined by administrative data) total cost for all potential drug seeking patients visits Success by measuring the number of patients that have “pain” who are found to have received multiple narcotic prescriptions from various providers Data analysis can show how these costly resources can be

10. Conclusion Prescription narcotic drug abuse is common and Urgent Care facilities are often frequented by these patients By allowing the provider access to information kept by the state, drug seeking patients can be “weeded out” , thereby freeing resources and easing the burden on providers, at urgent care facilities throughout the state of New Mexico Patient quality of care can be increased by allowing providers more time with patients in need and allow providers the ability to know what narcotic medications the patient is taking Providing a means of screening for potential narcotic seeking patients can be another tool to aid providers in patient care, and save limited resources

11. Resources Benak LD, Eccher D, McKinney RE, Smith CM. 2007. Prescription drug monitoring through the Maine Office of Substance Abuse. J Forensic Nurs. 2007 Fall-Winter;3(3-4):141-5. Brushwood DB. 2003. Maximizing the value of electronic prescription monioring programs. J Law Med Ethics 2003;31:41–54. Edlund MJ, Sullivan M, Steffick D, Harris KM, Wells KB. 2007 Do users of regularly prescribed opioids have higher rates of substance use problems than nonusers? Pain Med. 2007 Nov-Dec;8(8):647-56. Huang B, Dawson DA, Stinson FS, Hasin DS, Ruan WJ, Saha TD, Smith SM, Goldstein RB, Grant BF. 2006. Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: Results of the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006 Jul;67(7):1062-73. Miller NS. 2004. Prescription opiate medications: medical uses and consequences, laws and controls. Psychiatr Clin North Am. 2004 Dec;27(4):689-708. Miller NS. 2006. Failure of enforcement controlled substance laws in health policy for prescribing opiate medications: a painful assessment of morbidity and mortality. Am J Ther. 2006 Nov-Dec;13(6):527-33. Miller, Michael, Brown, Randall. 2007. Prescription Drug Monitoring Programs American Family Physician - Volume 75, Issue 6. Manchikanti L. 2006. Prescription drug abuse: what is being done to address this new drug epidemic? Testimony before the Subcommittee on Criminal Justice, Drug Policy and Human Resources. Pain Physician. 2006 Oct;9(4):287-321. Manchikanti L. 2007. National drug control policy and prescription drug abuse: facts and fallacies. Pain Physician. 2007 May;10(3):399-424. Shapiro RS. 1994. Legal bases for the control of analgesic drugs. J Pain Symptom Manage. 1994 Apr;9(3):153-9. Woolf CJ, Hashmi M. 2004. Use and abuse of opioid analgesics: potential methods to prevent and deter non-medical consumption of prescription opioids. Curr Opin Investig Drugs. 2004 Jan;5(1):61-6. Zacny J, Bigelow G, Compton P, Foley K, Iguchi M, Sannerud C. 2003. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement. Drug Alcohol Depend. 2003 Apr 1;69(3):215-32.