JMIR Publications

ABSTRACT

Background:

Reviewing the prescription drug monitoring program (PDMP) before signing a controlled medication prescription is a best practice to improve opioid safety and is legislatively mandated in most states. Mandating provider actions have unintended costs including workflow interruptions and misapplying provider time. The evidence supporting PDMP effectiveness is mixed, exacerbating the knowledge gap regarding mandating PDMP use. Prior PDMP evaluations have been limited by low rates of PDMP use and an inability to link encounter level PDMP review with patient outcomes. Clinical decision support (CDS) is an effective implementation strategy which is advantageous in collecting clinical data on PDMP use and prescribing decisions.

Objective:

This study aims to evaluate if user-centered CDS, which imports PDMP data into existing workflows, improves PDMP use and patient safety while reducing provider work.

Methods:

This is an electronic health record (EHR)-embedded, randomized control trial of 2 clinician-facing active choice CDS alerts to facilitate mandatory PDMP review vs usual care. One CDS, “mandated alert,” interrupts providers when prescribing an opioid or benzodiazepine with a link suggesting providers open the EHR-integrated state PDMP interface.

Results:

Utilizing user-centered design, we developed a second “smart” mandated CDS with the same rules-based logic and suggestion to check the PDMP, but also displays patient-specific data imported from the PDMP (number of active narcotic, sedative, and stimulant filled prescriptions). The aim of adding PDMP data to CDS is to facilitate PDMP utilization while decreasing unnecessary provider work when additional PDMP information is not needed. Providers were randomized and balanced by setting (349 inpatient, 354 emergency department and 751 outpatient). Both CDS alerts will be implemented within a single health system with a shared EHR and compared to usual care (no CDS). The primary outcome will be PDMP use. Secondary outcomes will be evaluated relative to encounter level PDMP use and include time spent prescribing, controlled medication prescription completion, and future opioid use by patients.

Conclusions:

This is a study protocol for a pragmatic, EHR-embedded randomized clinical trial optimizing a CDS implementation strategy to improve PDMP utilization while decreasing provider work. Implementation and effectiveness outcomes will be examined using the RE-AIM framework. Clinical Trial: NCT06215560 registered 5/6/24