Study shows prescription drug monitoring programs influence clinical decision-making impacting patient outcomes

A recent study by Monash University researchers has found that prescription drug monitoring programs (PDMP) can impact healthcare providers’ clinical decisions, resulting in both positive and negatives outcomes for patients.

The systematic review analysed the findings of 39 studies conducted in the United States between 2005 and 2021 to understand how PDMP use influences the recommendations or actions healthcare providers make in relation to a patient’s treatment.

PDMPs are a public health initiative designed to reduce harms associated with increased opioid prescribing. They use electronic databases that collect and monitor information on the prescribing and dispensing of ‘high-risk’ medications to patients.

Monash Addiction Research Centre (MARC) PhD candidate, Louisa Picco, who led the study, said previous research had looked at the effects of PDMPs on population outcomes such as changes in opioid prescribing, yet little was known about the actual clinical decisions that healthcare providers make and the impact of these decisions on patients.

“This is the first systematic review exploring how PDMP utilisation actually influences healthcare providers’ clinical decision-making. Understanding how the information within PDMPs is informing clinical practice and outcomes for patients is key to the success of these tools,” said Ms Picco.

The study analysed how PDMP utilisation influenced the clinical decision-making of healthcare providers, including physicians, nurse practitioners, dentists, osteopaths and pharmacists across various settings such as private practice, hospitals and community pharmacies. It identified PDMP use influenced clinical decision-making relating to seven broad themes including the supply of controlled substances, refusal to prescribe or treat, risk mitigation strategies, communication, education and counselling, referrals and care coordination, and stigma.

It found the most common clinical decision was in relation to the supply of controlled substances, reported in 21 studies, with decreased prescribing the most prevalent clinical decision.

“The information within PDMPs allows prescribers to make more informed decisions around the supply of medications as they can see all monitored medications prescribed and dispensed to patients,” said Ms Picco.

Another common clinical decision made by healthcare providers was to refuse to prescribe or treat patients, with 19 studies reporting various forms of medication or treatment refusal. PDMP use resulted in some healthcare providers not accepting new patients or refusing to prescribe opioids to new patients.

“Refusing to treat or supply medication can have detrimental effects for patients and abruptly stopping medications should be avoided where possible. Unfortunately we found that this was a common clinical decision made by healthcare providers and is an unintended consequence of these tools,” said Ms Picco.

The review also found that PDMPs are effective in mitigating risks to patients by providing healthcare providers with a patient profile that would allow them to make informed decisions, such as prescribing the opioid antagonist medication, naloxone. PDMP use also encouraged discussions between healthcare providers and patients, improved communication between prescribers and pharmacists, and assisted clinicians to work together with other health care professionals or services to coordinate the care of a patient.

While there are currently no clinical or best practice guidelines for PDMP use, the findings of the study suggest that these could be beneficial in helping healthcare providers make appropriate clinical decisions based on information with PDMPs and other clinical tools.

“Given the recent implementation of Victoria’s own real-time PDMP ‘SafeScript’ these findings are crucial to the successful adoption and use of PDMPs and for planned future implementation in other states in Australia,” said Ms Picco.