Prescription Behavior Surveillance System (PBSS): Prescriber Initiatives

Multiple studies have found an association between increased opioid prescribing – in the amount prescribed per prescription, total days’ supply, and number of prescriptions per patient – and increased morbidity and mortality in the U.S. over the last 10 to 15 years.  At the same time, much effort from both public and private sectors has been put forth to facilitate safer prescribing of opioids and other controlled substances.  However, there remains a substantial gap between the optimal standard for prescribing opioids and actual medical practice.  The Prescription Behavior Surveillance System (PBSS) Project involves two phases related to prescriber initiatives: 1) systematic literature review of evaluated initiatives was conducted to assess the existing evidence base and gap in knowledge about efficacious methods to influence safer prescribing of opioids; and 2) evaluation of a prescriber initiative is underway using the PBSS multi-state prescription drug monitoring program (PDMP) database.  A typology was developed from the wide range of evaluated prescriber initiatives: 1) comprehensive education, 2) best practices/guidelines, 3) PDMP use, and 4) mandates. While all four general categories of prescriber initiatives show positive results in influencing safer prescribing practices, there is considerable variation in the evidence base across and within the categories. Findings from the literature review and our PBSS evaluation project will be reported.  Using PDMP data rather than relying primarily on self-reported surveys as utilized in many of the existing evaluations may provide further evidence and even incentive to change prescribing behaviors and thereby help mitigate the prescription drug abuse epidemic.