Identifying Providers with Unusual Prescribing Practices for Controlled Substances

The abuse of prescription medications has become a critical point of discussion in the mainstream media and in law enforcement. A report recently released by the National Institute of Justice takes a look at algorithms designed to identify health care providers that may be over-prescribing controlled substances, utilizing one state's prescription drug monitoring program.

The report, Use of a Prescription Drug Monitoring Program to Develop Algorithms to Identify Providers with Unusual Prescribing Practices for Controlled Substances, written by Christopher Ringwalt, Sharon Schiro, Meghan Shanahan, Scott Proescholdbell, Harold Meder, Anna Austin, and Nidhi Sachdeva, explains:

Contributing to the problem of misuse, abuse, and diversion of controlled substances are providers who over-prescribe these substances. Using one state’s prescription drug monitoring program, this report describes a series of metrics developed to identify providers manifesting unusual and uncustomary prescribing practices.

Researchers also present the results of a preliminary effort to assess the concurrent validity of these algorithms, using death records from the state’s vital records database pertaining to providers who wrote prescriptions to patients who then died of a medication or drug overdose within 30 days. Metrics manifesting the strongest concurrent validity with providers identified from these records related to those who co-prescribed benzodiazepines, such as valium, and high levels of opioid analgesics, such as oxycodone, as well as those who wrote temporarily overlapping prescriptions.

Many of the strategies that have been implemented to address the epidemic have focused on prescribers’ utilization of state-level prescription drug monitoring programs (PDMPs) to reduce access to controlled substances by patients at high risk of opioid misuse, abuse, and diversion. PDMPs, which as of October 2014, were operational in all states but Missouri, constitute databases that providers and dispensers can consult to learn their patients’ histories of filled prescriptions for controlled substances. These registries have been developed to promote appropriate prescribing practices and detect fraudulent behavior.

Currently, providers with unusual patterns of prescribing behavior may be identified through a variety of idiosyncratic strategies, including complaints from patients or colleagues, audits of medical records, or investigations by coroners or chief medical examiners.

The development of accurate and efficient algorithms that yield lists of prescribers manifesting unusual prescribing patterns that maximize true positives and minimize false positives present multiple challenges. But the results, if obtainable, would be well worth the effort, particularly if they are utilized in conjunction with other strategies, such as clear guidelines governing prescribing practices related to controlled substances, and automated warning letters or email messages to providers whose prescribing patterns have been identified as unusual and potentially uncustomary.

You can read the full report here.

Source: NIJ

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