K-TRACS: Review of Program Data and a Qualitative Assessment Study

Transcription

1 K-TRACS: Review of Program Data and a Qualitative Assessment Study Amy Curry, MD Clinical Assistant Professor University of Kansas School of Medicine - Wichita Department of Family and Community Medicine Associate Director Via Christi Family Medicine Residency Program 1

2 Objectives 1. Describe the K-TRACS program and data 2. Review the current literature on PDMPs 3. Discuss the findings of a qualitative K-TRACS assessment study 4. Explore greater use of the K-TRACS system in facilitating the physician-pharmacist team model 5. Encourage 2

3 The Decade of Pain :

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6 K-TRACS Definition: Kansas Tracking and Reporting of Controlled Substances On-line, web-based computer application Allows Licensed Healthcare providers to access patient s controlled substance prescription history 6

7 K-TRACS Mission To Promote the Appropriate use of Controlled Substances for Legitimate purposes To Deter the Misuse, Abuse, and Diversion of Controlled Substances 7

8 K-TRACS Healthcare tool in Chronic Pain Management -confirm a patient s history -monitor compliance with treatment -coordinate plan of care -identify diversion and abuse 8

9 History 2008: Mandated by Kansas law February, 2011: Mandatory Weekly Dispenser reporting April, 2011: On-line Query Access available Present: Mandatory Daily Dispenser reporting with data back to July,

10 K-TRACS Oversight: Kansas State Board of Pharmacy Employees: 2 Funded: No sustainable funding National Association of Boards of Pharmacy 10

11 K-TRACS Current number of registered users: 6,593 Number of in-state queries as of the first quarter, 2013: 51,334 Number of inter-state queries as of the first quarter, 2013:

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13 K-TRACS Advisory Committee Physicians: 2 KMS KAOM Pharmacists: 2 Dentist: 1 KBI: 1 KU-SOM: 1 KU-SOP: 1 Kansas Hospital Association: 1 Others: ARNP Appointments: 3 years No compensation 13

14 K-TRACS Database of all the following medications dispensed in or into the state of Kansas : 1. Scheduled II-IV controlled substances 2. Drugs of Concern 14

15 1. Tramadol Drugs of Concern 2. Prescription pseudoephedrine 3. Medications that contain all three: butalbital, caffeine, and acetaminophen 15

16 Drug Dose Dosage instructions Quantity Day s supplied Prescriber Dispenser Patient Updated weekly Data Reported 16

17 Data Disclosure Patient or legal representative Prescriber Dispenser Licensed delegate-2 17

18 Delegates Licensed, registered or certified by a state regulatory or administrative agency Need own password Provider is responsible for delegate s use Provider should review delegate s use history periodically Provider should notify K-TRACS if delegate no longer in that role 18

19 Data Disclosure Law enforcement with permission Licensing agency Research/Education: de-identified data KHPA Medicaid recipients K-TRACS Board and staff 19

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21 HIPAA and Liability No patient consent needed to report, access or discuss data Prescribers and Dispensers can discuss data with other Providers: for the purpose of providing medical or pharmaceutical care to their patients No person authorized to prescribe or dispense scheduled substances and drugs of concern shall be liable to any person in a civil action based on K-TRACS. 21

22 Duty Nothing in this act shall be construed to create a duty or otherwise require a person authorized to prescribe or dispense scheduled substances and drug of concern to obtain information about a patient from the prescription monitoring program prior to prescribing or dispensing scheduled substances and drug of concern to such patient 22

23 K-TRACS MONITORING 23

24 Patient Threshold Letters Data reviewed quarterly Patients who trigger a threshold: 5 physicians 5 pharmacies or 10 physicians 1 pharmacist or vice versa in 3 months time. Sent to prescribers and dispensers Purpose: Inform 24

25 Total Threshold Letters Patient, Pharmacist, Prescriber: 1606: 2 nd Quarter, : 1st Quarter,

26 Patient Threshold Letters Quarter Number of Patients Most Pharmacies Most Physicians 1Q Q Q Q Q Q Q Q Q

27 Pharmacy Threshold Letters 411: 1st Quarter, : 1st Quarter,

28 Prescriber Threshold Letters 1206: 2 nd Quarter, : 1st Quarter,

29 1 st Quarter 2011 Top Recipients Meeting Threshold Age Gender LI City State Total Quantity Number of Pharmacies Number of Physicians 31 Female B Olathe KS Female H Olathe KS Male S Tonganoxie KS Male S Mission KS Male B Kansas City MO Female S Tonganoxie KS Yates 30 Male R Center KS Female H Louisburg KS Overland 41 Female I Park KS Male G Edgerton KS

30 1 st Quarter 2013 Top Recipients Meeting Threshold Age Gender LI City State Total Quantity Number of Pharmacies Number of Physicians 37 Female B Stilwell KS Female B Olathe KS Male P Salina KS Female N Gardner KS Female M Overland Park KS Male L Gardner KS Female E Kansas City KS Female H Birmingham MO Female L Kearney MO Female D Quenemo KS I 30

31 Peer Review Committee Volunteers from Advisory Committee 3 Physicians 3 Pharmacists Identify patterns and activities of concern Patient, Prescriber or Dispenser Empowered to make Referrals to: Law enforcement Regulatory/Licensing agency Educational or Professional Advising 31

32 K-TRACS Real World 32

33 PDMP Research Slows the increase in quarterly rates of opioid treatment admissions: States with PDMPs: 2.6% States without PDMPs: 4.9% 1 Decreases doctor shopping 2 Decreased law enforcement investigation time by 80-90% 3 33

34 PDMP Resident Doctors use increases with Attending use 4 Alters prescribing habits 2-1/3 rd of Attending Doctors increased the quantity or amount based on data 4 -Data altered plan 41% of time in ER study: 61%: decreased the number of opioid scripts 39%: increased the number of opioid scripts 5 34

35 SHOPPERS Doctor and Pharmacy Shopping for Controlled Substances was associated with Drug-related Overdose Deaths: 25% vs 3.5%-Doctor Shoppers 17.4% vs 1.3%-Pharmacy Shoppers 6 35

36 Results of a Qualitative Assessment of the Kansas Tracking and Reporting of Controlled Substances (K-TRACS) System Amy Curry, MD¹, Alisa Schmidt, MD¹, Rose Dulaney, DO¹, Amy Chesser, PhD¹, Anne Burke, MS¹, Bob Emerson, Pharm.D., R.Ph², Rick Kellerman, MD¹ ¹KUSM W, Department of Family and Community Medicine ²KUSM W, Department of Pharmacy Practice 36

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38 K-TRACS Qualitative Assessment KU-School of Pharmacy & School of Medicine Convenience sample of users Interviewed Physicians and Pharmacists 24 providers interviewed 16 communities across Kansas Qualitative 38

39 K-TRACS Interview Locations 39

40 Study Objectives Document use of K-TRACS Identify barriers and facilitators to use of K- TRACS Assess the impact of K-TRACS Patient Community Practice Chronic Pain Management 40

41 K-TRACS Utility Use: 23/24 Settings: Pharmacies, Clinics, Emergency Rooms, Hospitals, Hospices Frequency: varied-occasional to frequent Who: Pharmacists, few docs, delegates 41

42 K-TRACS Utility When: - New/unknown patients - New/unknown prescriber - Unusual dosing/quantity/medication - Cash-paying - Suspicious Patient Behavior - Prescriber of concern 42

43 K-TRACS Barriers Never applied for access Forgotten password Lack of Computer skills Website Interruption of workflow -Time -Lack of Internet access 43

44 K-TRACS Problems Delayed reporting Lack of neighboring state data Identification number transition Reports -Confusing Unreliable compounding reporting Inability to delete re-shelved prescriptions 44

45 Improved - Patient safety - Community safety - Practice continuity - Provider safety K-TRACS Benefits Comfortable Confident 45

46 K-TRACS Benefits Empowered: -To set boundaries in our practices -To voice our concerns: Patient abuse and addiction Each other 46

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49 K-TRACS Benefits Improved Physician/Pharmacist communication Altered prescribing habits Provided a protected structure for reform with accountability Facilitate Team approach to medical care 49

50 References 1. L. Reifler, et al., Do Prescription Monitoring Programs Impact State Trends in Opioid Abuse/Misuse? Pain Medicine 13(30)2012: J. Worley, Prescription Drug Monitoring Programs, A Response to Doctor Shopping: Purpose, Effectiveness, and Directions for Future Research. Issues in Mental Health Nursing 33(5)2012: US. General Accounting Office, Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion, GAO , May 2002, p.3, 4. L. Feldman, et al. Influencing Controlled Substance Prescribing: Attending and Resident Physician use of a State Prescription Monitoring Program. Pain Medicine 13(7)2012: D. Baehren, et al. A Statewide Prescription Monitoring Program Affects Emergency Department Prescribing Behaviors. Annals of Emergency Medicine 56(1)2010: GL. Peirce, et. al. Doctor and Pharmacy Shopping for Controlled Substances. Medical Care 50(60) 2012:

51 Contact Information Amy E. Curry, MD Associate Director Via Christi Family Medicine Residency Program 707 N. Emporia Wichita, KS