Physicians’ Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-State Qualitative Study
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.
To evaluate VA physicians’ perspectives and experiences regarding use of PDMPs to monitor Veterans’ receipt of opioids from non-VA prescribers.
Qualitative study using semi-structured interviews.
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).
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.
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.
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 WORDSVeterans opioids qualitative research prescription drug monitoring programs
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.
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.
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.
- 1.Opioid Overdose. Available at https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed on May 3, 2017.
- 2.Overdose Death Rates. Available at https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed on May 3, 2017.
- 3.10 Leading Causes of Injury Deaths by Age Group Highlighting Unintentional Injury Deaths, United States—2010. Available at https://www.cdc.gov/injury/wisqars/pdf/10LCID_Unintentional_Deaths_2010-a.pdf. Accessed on May 3, 2017.
- 5.Gellad WF, Zhao X, Thorpe CT, Thorpe JM, Sileanu FE, Cashy JP, Mor M, Hale J, Radomski TR, Hausmann LRM, Fine MJ, Good CB. Overlapping Buprenorphine, Opioid, and Benzodiazepine Prescriptions among Veterans Dually Enrolled in VA and Medicare Part D. Substance Abuse. 2017; 38(1):22–25.CrossRefPubMedGoogle Scholar
- 6.Gellad WF, Thorpe JM, Zhao X, Thorpe CT, Sileanu FE, Cashy JP, Hale J, Mor M, Radomski TR, Hausmann LRM, Donohue JM, Gordon AJ, Suda KJ, Stroupe KT, Hanlon JT, Cunningham FE, Good CB, Fine MJ. Impact of dual use of va and medicare part d drug benefits on potentially unsafe opioid use. Am J Public Health. 2018; 108(2):248–255.Google Scholar
- 10.U.S. Department of Veterans Affairs. 2011 Survey of Veteran Enrollees’ Health and Reliance Upon VA. Available at: http://www.va.gov/healthpolicyplanning/soe2011/soe2011_report.pdf. Accessed on 24 May 2015.
- 11.Gasper J, Liu H, Kim S, May L. 2015 Survey of veteran enrollee’s health and use of health care. http://www.va.gov/HEALTHPOLICYPLANNING/SoE2015/2015_VHA_SoE_Full_Findings_Report.pdf. Accessed 31 March 2017.
- 15.Status of Prescription Drug Monitoring Programs (PDMPs). Available at http://www.pdmpassist.org/pdf/PDMPProgramStatus.pdf. Accessed on May 3, 2017.
- 16.Weiner J, Bao Y, Meisel Z. Prescription drug monitoring programs: evolution and evidence. Available at https://ldi.upenn.edu/brief/prescription-drug-monitoring-programs-evolution-and-evidence. Accessed on June 29, 2017.
- 19.Lin DH, Lucas E, Murimi IB, Jackson K, Baier M, Frattaroli S, et al. Physician attitudes and experiences with Maryland’s Prescription Drug Monitoring Program (PDMP). Addiction. 2016.Google Scholar
- 20.Carnes NA, Wright ER, Norwood CW. A qualitative analysis of prescribers’ and dispensers’ views on improving prescription drug monitoring programs. Res Social Adm Pharm. 2016.Google Scholar
- 23.Comprehensive Addiction and Recovery Act of 2016, 42 U.S.C. §§ 114–198. 2016.Google Scholar
- 24.Consolidated Appropriations Act of 2016.Google Scholar
- 26.Miller W, Crabtree BF. Primary care research: a multi typology and qualitative road map. In: Crabtree BF, Miller WL, eds. Doing qualitative research. London: Sage Press, 1992. pp 3–30.Google Scholar
- 27.Barnett JM. Review Note: Benjamin Crabtree & William Miller (Eds.) 2002.Google Scholar
- 28.Doing Qualitative Research (2nd ed.) [20 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research [On-line Journal], 3(4). Available at: http://www.qualitativeresearch.net/fqs/fqs-eng.htm.
- 29.Providing Health Care for Veterans. Available at https://www.va.gov/health/. Last accessed on June 6, 2017.
- 30.Briefing on PDMP Effectiveness. PDMP Center of Excellence at Brandeis. Available at http://www.pdmpassist.org/pdf/COE_documents/Add_to_TTAC/Briefing%20on%20PDMP%20Effectiveness%203rd%20revision.pdf. Accessed on May 9, 2017.
- 31.Pardo B. Do more robust prescription drug monitoring programs reduce prescription opioid overdose? Addiction. 2016. https://doi.org/10.1111/add.13741.
- 32.Reilly C. Improvements to prescription drug monitoring programs can help stop overdose deaths. Available at http://www.pewtrusts.org/en/research-and-analysis/analysis/2016/02/11/improvements-to-prescription-drug-monitoring-programs-can-help-stop-overdose-deaths. Last Accessed on July 3, 2017.