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Physicians’ Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-State Qualitative Study

  • Thomas R. Radomski
  • Felicia R. Bixler
  • Susan L. Zickmund
  • KatieLynn M. Roman
  • Carolyn T. Thorpe
  • Jennifer A. Hale
  • Florentina E. Sileanu
  • Leslie R. M. Hausmann
  • Joshua M. Thorpe
  • Katie J. Suda
  • Kevin T. Stroupe
  • Adam J. Gordon
  • Chester B. Good
  • Michael J. Fine
  • Walid F. Gellad
Original Research

Abstract

Background

The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients’ receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA.

Objective

To evaluate VA physicians’ perspectives and experiences regarding use of PDMPs to monitor Veterans’ receipt of opioids from non-VA prescribers.

Design

Qualitative study using semi-structured interviews.

Participants

Forty-two VA primary care physicians who prescribed opioids to 15 or more Veterans in 2015. We sampled physicians from two states with PDMPs (Massachusetts and Illinois) and one without prescriber access to a PDMP at the time of the interviews (Pennsylvania).

Approach

From February to August 2016, we conducted semi-structured telephone interviews that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use.

Key Results

VA physicians broadly supported use of PDMPs or desired access to one, while exhibiting varying patterns of PDMP use dictated by state laws and their clinical judgment. Physicians noted administrative burdens and incomplete or unavailable prescribing data as key barriers to PDMP use. To facilitate use, physicians endorsed (1) linking PDMPs with the VA electronic health record, (2) using templated notes to document PDMP use, and (3) delegating routine PDMP queries to ancillary staff.

Conclusions

Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids.

KEY WORDS

Veterans opioids qualitative research prescription drug monitoring programs 

Notes

Acknowledgements

We would like to acknowledge Peter Glassman, M.B.B.S. and Scott Herrle, M.D., M.S. for their assistance in pilot testing the interview script.

Prior Presentations

This paper has been presented at the Society of General Internal Medicine National Meeting in Washington, D.C. in April, 2017, and at the Academy Health National Meeting in New Orleans, LA in June 2017.

Funding

This project was funded by the VA Health Services Research and Development Merit Review Award (IIR 14-297). Dr. Radomski received support from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR001856. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Department of Veterans Affairs, or the US Government.

Compliance with Ethical Standards

The final interview script and study protocol were approved by the Institutional Review Board of the VA Pittsburgh Healthcare System. Participants were consented to be audio-recorded prior to the interviews.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4374_MOESM1_ESM.docx (27 kb)
ESM 1 (DOCX 27 kb)

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Copyright information

© Society of General Internal Medicine (outside the USA) 2018

Authors and Affiliations

  • Thomas R. Radomski
    • 1
    • 2
    • 3
  • Felicia R. Bixler
    • 1
  • Susan L. Zickmund
    • 4
  • KatieLynn M. Roman
    • 1
  • Carolyn T. Thorpe
    • 1
    • 5
  • Jennifer A. Hale
    • 1
  • Florentina E. Sileanu
    • 1
  • Leslie R. M. Hausmann
    • 1
    • 2
  • Joshua M. Thorpe
    • 1
    • 5
  • Katie J. Suda
    • 6
  • Kevin T. Stroupe
    • 6
  • Adam J. Gordon
    • 4
  • Chester B. Good
    • 1
    • 2
    • 5
  • Michael J. Fine
    • 1
    • 2
  • Walid F. Gellad
    • 1
    • 2
  1. 1.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA
  2. 2.Division of General Internal Medicine, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Center for Research on HealthcarePittsburghUSA
  4. 4.VA Salt Lake City Healthcare SystemSalt Lake CityUSA
  5. 5.Department of Pharmacy and TherapeuticsUniversity of Pittsburgh School of PharmacyPittsburghUSA
  6. 6.Edward Hines Jr. VA HospitalHinesUSA

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