Wednesday, December 4, 2013

The PDMP is Showing Progress

The Florida Office of Judges of Compensation Claims issues an annual report each year pursuant to Fla. Stat. 440.45. Reporting is something addressed by a variety of agencies. I sometimes wonder if anyone has the time to read all of these reports. I ran across an interesting report published last Sunday by the Department of Health, the Prescription Drug Monitoring Program (PDMP) Annual Report.

Prescription Drug Monitoring has been adopted in various jurisdictions in recent years. Experts around the country have proposed and championed these programs as a tool to constrain the provision of medication to patients, and to discourage its redistribution. 

There are those patients who treat with a single physician for all of their maladies and conditions, and that physician knows both the nature and quantity of all of the medications that patient consumes. The physician in that setting has information necessary to avoiding dangerous mediation interactions, and can effectively control the amount of medication taken by the patient. It may be difficult for the physician to know that she/he is the only one providing care. In this setting the physician is dependent on the patient for information as to what other physicians or providers she/he may be seeing.

There are other patients who treat with multiple physicians, for whatever reason(s). These patients may be provided with prescriptions or even the medication itself by various physicians. In this setting, the physician is dependent on the patient for accurate information as to what medication and doses she/he is consuming from the other physicians. 

A significant driver in the quest for PDMP is the pain medication market. There are a variety of products in the marketplace for relief of pain, many of them based on opium, called "opiates" or "opiods." A population of Americans are dependent upon or addicted to medications such as these. 

The PDMP is designed to provide physicians with information about the types and quantities of medication a patient is receiving, to augment the information provided by the patient. When a patient receives medication, that information is placed in the PDMP database, so that other physicians and pharmacies can see what that patient has already received. According to the State Surgeon General, the PDMP goal is to "protect, promote, and improve the health of all people in Florida."

Several States have implemented PDMP programs. Florida implemented ours in 2009. There are about 19 million people in Florida. That is a significant amount in any context. However, there are also a fair volume of older Floridians as we remain a retirement destination despite recent economic challenges. It may be that these older Floridians are more likely to require prescription medications. Thus delivery of medical care in Florida is perhaps as intense as in any state.

Since the Florida PDMP was implemented, over "87 million controlled substance prescriptions" have been loaded into the PDMP. Last year, more than 3.7 million queries of this database were made by doctors and pharmacists in the course of filling new or refill prescriptions. This is significant in sheer volume. What is more significant however is that this represents a "61 percent increase over the (queries the) prior year." 

Another measure of success, the Report says that health care provider registrations increased 28 percent in 2012-13. These may very well illustrate significant success. It is important that health care providers utilize this database, and to do so they must be registered. However, the law of numbers tells us that with increasing participation, percentage increases each year will become less significant. For example, assume there are 100 doctors in Florida. If 18 physicians register the first year, and five physicians register the second year, that is an increase of 28 percent. If five more register the next year, that is only 21 percent. 

More importantly, is that eventually the five additional physicians each year in this mathematical illustration will result in all the physicians being registered with the PDMP. For this reason, the queries, that is usage, is likely a better measure of success in the long-run than the volume of providers that are added annually. The physicians added each year as a percentage of those licensed in the state would be a more informative short-term measure of success in terms of how aware physicians are of the PDMP and their interest in using it. 

The best measure of success, however, is in the end result. The goal here is to reduce prescription drug abuse, misuse and what they call "diversion," which is the medicine being transferred from the patient to someone else by loss, theft, or sale. The end result that is desired is better control of these drugs. The Report notes that deaths caused by the opiate Oxycodone "plunged" 41 percent in Florida last year, "and overall drug deaths fell 9.9 percent." This is in a single year. That is significant. 

Also significant is that the number of people "receiving prescriptions from five or more pharmacies" decreased 51 percent. Death from prescriptions is decreasing. Gaming the process, through use of multiple pharmacies, and by implication perhaps multiple physicians, is decreasing markedly. I am not convinced that Florida can declare victory in the battle against senseless prescription drug deaths. However, I am impressed  that this Report signals real progress in what is a real problem for Floridians.

Perhaps the Legislature will move to a mandatory process to amplify these successes. What harm would there be in requiring provider registration with the PDMP? Is there any reason for every physician not to be registered? Further, is there any reason for not requiring every physician to query the database before prescribing a controlled substance?

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