115 - “It gives us better information, more accurate information”: Compelling Narratives from Evaluating Kentucky’s Prescription Drug Monitoring Program

Abstract Information: Between 1999 and 2021, more than 1 million people died from a drug overdose; over 644,000 people died from an opioid-involved overdose, with over 279,000 of those deaths involving prescription opioids (CDC WONDER, 2023). In 2021, Kentucky had the fifth highest age-adjusted overdose fatality rate in the United States (CDC WONDER, 2023). A promising state-level tool, prescription drug monitoring programs (PDMPs) are used to track prescribing behaviors and can alert clinicians to opportunities to provide potentially life-saving information and interventions used to address prescription opioid misuse. Kentucky is an example of a model state, as it enhances and maximizes connectivity by supporting multiple pathways to integration via the Kentucky All Schedule Prescription Electronic Reporting (KASPER) PDMP. Through a strong partnership between KASPER and the Kentucky Injury Prevention & Research Center (KIPRC), the utility of PDMPs as a public health surveillance and clinical decision-making tool has been enhanced. Through a mixed-methods approach, we explored barriers, facilitators, and outcomes of integrating KASPER data into electronic health records and pharmacy dispensing software. Presenters will describe this case study evaluation design and share findings using compelling narratives from interviews and quantitative analyses of aggregated state prescription data to describe system use and its effect on clinician and patient behaviors. Sharing this evaluation as a promising practice can help other states improve their PDMP functionality as a public health surveillance tool and help facilitate enhanced data integration into electronic clinical decision support tools and quality improvement measures as an overdose prevention strategy.

Relevance Statement: In 2021, over 106,000 drug overdose deaths occurred in the United States (CDC WONDER, 2023). The drug overdose epidemic has called for accessible and timely data which can be used to inform clinical decisions and overdose prevention efforts such as linkage to care for opioid use disorder. Prescription drug monitoring programs (PDMPs) are state-level electronic databases that track controlled substance prescriptions. These electronic databases are used to track prescribing behaviors and can be used to address prescription opioid misuse and inform overdose prevention efforts. Additionally, PDMPs include critical data for healthcare providers about patient prescribing that can be integrated into clinical decision support tools. This information equips clinicians with data and resources within the patient encounter while also helping support, not replace, care that is individualized, flexible and patient centered. Kentucky has collaborated with partners to integrate their state PDMP data from the Kentucky All Schedule Prescriptions Reporting system, KASPER, into select health system electronic health records (EHRs) and pharmacy dispensing software at select pharmacies, which has fostered clinician access to timely and accurate patient data needed to make well-informed clinical decisions at the point-of-care. Using storytelling as a tool for understanding how people perceive their experiences is a powerful way to inform evaluation and program improvements by providing meaningful qualitative data. Gathering the perspectives of those who leverage the system's information efficiently and maximize its uses yields valuable knowledge of its benefits, which catalyzes support for widespread utilization. In this evaluation, we interviewed clinicians and system administrators to understand their experience using and managing the system, in order to assess KASPER’s impact on Kentucky’s pioneering PDMP integration approach and prescribing and patient behaviors. The interviews revealed how each participant currently uses PDMP data, the clinical impact on their practices and their recommendations for future improvements. The findings from this evaluation may inform efforts by others in establishing or evaluating their own PDMP-EHR integration methods. It is critical to explore this innovative approach, as prescribing and patient behavior data from this evaluation suggests the benefits of integration. In this panel, we will share this case study evaluation as a promising practice that can help other jurisdictions consider ways to improve PDMP functionality as both a clinical decision support and a public health tool and facilitate PDMP-EHR integration as one of the many strategies that can help reduce overdose. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2021 on CDC WONDER Online Database, released in 2023. Data are from the Multiple Cause of Death Files, 2018-2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-expanded.html on Mar 14, 2023, 2:16:53 PM