Survey finds that usability barriers dampen participation yet nearly three-quarters who use state databases report prescribing fewer opioids
In a new survey, researchers at the Johns Hopkins Bloomberg School of Public Health found that physicians report relatively high awareness of state databases that track drug prescriptions but more than one-fifth indicated they were not aware of their state's program at all.
In a survey of 420 primary care physicians published in the March issue of the journal Health Affairs, the researchers found that 72 percent indicated they were aware of their state's program, and 53 percent reported they'd used their state's program. Another 22 percent indicated they had no knowledge of their state's program.
This is believed to be the first national survey examining physicians' awareness and use of Prescription Drug Monitoring Programs, state-run databases that track prescriptions classified as federal controlled substances, including opioids. The programs are considered an important intervention aimed at curtailing prescription drug abuse and misuse, which has reached epidemic proportions in the United States. An estimated one-third of people aged 12 or older who used opioids for the first time in 2009 began by using a prescription drug without a prescription.
The databases allow prescribing physicians to identify "doctor shoppers" -- people who obtain prescriptions from multiple physicians, either to use or to sell or both -- and other potentially illicit or abusive behaviors. Every state but Missouri has a prescription drug-monitoring program in place.
The survey also assessed physicians' perceptions of program usability, ease of accessing the data as well as barriers to using the data. Nearly three-quarters - 74 percent - found accessing the data to be "very easy" (31 percent) or "somewhat easy" (38 percent). But when it came to using the data, 58 percent reported that the information was too time-consuming to retrieve and 28 percent indicated that the information was not in an easy-to-use format.
"The success of these programs depends on physicians' knowledge, impressions and use of them," says study leader Lainie Rutkow, JD, PhD, an associate professor in the Department of Health Policy and Management at the Bloomberg School. "While awareness of the programs is relatively high, barriers exist. The information in our report about the barriers physicians face will give states something to focus on."
The programs are relatively new, with the earliest ones introduced in the past decade and newer ones in various stages of rollout. In the past three years, 12 states introduced prescription drug monitoring programs. They vary from state to state, but by and large require doctors and/or pharmacists to enter information about prescriptions and dispensing of drugs so they can be tracked. In some states, law enforcement has access to the databases.
As for the 22 percent who reported not knowing about the programs, Rutkow says the figure is not as alarming as it might suggest because in many states the programs are new and physicians may not be aware of the rollout. Still, Rutkow notes that this finding represents an opportunity for states to communicate with physicians about their programs.
One challenge the programs face is the lack of information sharing between states. "It's a goal of course to ultimately have interstate interaction, especially in large urban areas that span multiple states," says Rutkow.
The authors note that physicians might use the programs more frequently if states addressed barriers to use. For instance, some states only give physicians access to the systems, which puts the burden of use on the doctor. Other states allow physicians to appoint a proxy, so someone else can do the work. Another problem is that in some state databases, the data are not clearly presented, making them difficult to access and interpret.
In addition to addressing the prescription drug epidemic, the state programs could have the unintended consequence of serving other valuable functions, including preventing adverse drug interactions. Given the widespread use of prescription drugs to treat chronic diseases, these programs may be useful for monitoring other types of prescriptions.