Due to the weather, some customers may experience late delivery of The Roanoke Times. We apologize for the delay.
Still, only an estimated 30 percent of prescribers in Virginia have used the service.
Sunday, March 17, 2013
As it approaches its 10th year of operation, Virginia’s prescription monitoring program is nearing a milestone.
The database of prescriptions — which allows doctors and other health care professionals to check the records of patients who might be abusing their medications — is expected to log more than 1 million requests for information this year, according to the state Department of Health Professions.
It will be the first time since the system went online in 2003 that annual queries have topped the 1 million mark. Six years ago, the system had just 22,156 requests for data.
“We’ve experienced pretty explosive growth,” said Ralph Orr of the Department of Health Professions, who directs the program.
But while the number of prescribers using the system has grown significantly, some say there’s still not enough buy-in.
The monitoring program was created a decade ago in response to reports of widespread prescription drug abuse in Southwest Virginia.
In a practice known as doctor-shopping, abusers go from one physician to another, complaining of a bad back or whatever ailment might allow them to accumulate a stash of pills.
The idea behind the monitoring program was that doctors, dentists and others could check someone’s prescription record to determine whether they were trying to game the system.
Prescriptions are entered into the database as they are filled at pharmacies across the state. Doctors who suspect a patient might be abusing drugs have the option to run the person’s name though the secure database, which holds nearly 85 million prescription records, but they are not required to do so.
Although most patients use their medications responsibly, the database has turned up cases in which some people have visited as many as 15 doctors and 15 pharmacies during a six-month period.
Today, with fatal overdoses and police reports showing that prescription drug abuse has yet to subside, efforts continue to get more health care professionals to use the program.
By one measure, just 30 percent of prescribers in Virginia have consulted the database.
There were 11,006 prescribers registered to use the system at the end of last year. Prescribers include doctors, dentists, podiatrists, physician assistants, nurse practitioners and in some cases medical residents.
The total number of prescribers in Virginia is difficult to determine, in part because some professionals with access to the database may not be in active practice. But Orr said his best estimate is about 37,000.
The numbers show that “we still have work to do,” said Sarah Melton, a clinical pharmacist who serves as chairwoman of the board of One Care of Southwest Virginia, a coalition formed to fight substance abuse.
Working with the Medical Society of Virginia and other organizations, One Care has been holding forums to educate health care providers about prescription drug abuse and encourage them to use the monitoring program.
Although many potential users have yet to access the system, officials said the overall participation rate of 30 percent is not the best indicator of its use.
A closer look at the numbers shows that health care providers who most often prescribe the type of medications tracked by the system are much more likely to use it.
Of the 421 prescribers who wrote 1,000 or more prescriptions in the fourth quarter of last year, 85 percent were registered to use the system, according to numbers from the Department of Health Professions.
As the number of prescriptions written by providers drops, so does their use of the database.
Among those who wrote between one and 24 prescriptions during the same time period — at 12,130 prescribers, the largest subset reviewed — the participation rate was just 14 percent.
No matter how the numbers are viewed, Virginia has one of the higher participation rates among the 43 states that have active prescription monitoring programs, according to a group that monitors such efforts.
“I would say that Virginia is one of the states that early on has tended to be very progressive in the use of this tool,” said Sherry Green, CEO of National Alliance for Model State Drug Laws .
While Virginia’s overall participation rate of 30 percent is higher than many states’, that number “distorts the issue a little bit,” Green said.
That’s because the total number of health care providers with access to the database includes those who might be involved in teaching, research or other fields in which they would not be prescribing medications, she said.
The best way to judge the system’s effectiveness, Green said, is to look at the participation of those who prescribe the most.
In Virginia, providers who wrote 100 or more prescriptions per quarter accounted for 85 percent of the transactions tracked by the monitoring system.
Even so, the remaining 15 percent of the prescriptions written in the last three months of 2012 amounted to as many as 4 million doses of medication, according to the Department of Health Professions.
“We want people to realize that even though they might not always prescribe controlled substances on a regular basis, there is utility to using this program,” Orr said.
At this year’s General Assembly session, a bill was introduced that would have required doctors and other health care providers to check the database before writing a prescription.
Sen. Phillip Puckett, D-Russell County , said the continuing problem with prescription drug abuse in the region prompted him to offer the bill.
The prescription monitoring program has been successful in curbing abuse to some degree, Puckett said.
“But I often wonder how much more successful it would be if we had even more prescribers participating in the program,” he said.
Puckett withdrew the bill, in part because of concerns raised by the pharmaceutical industry and the Medical Society of Virginia.
While the society encourages more physicians to use the database, it opposes a governmental mandate.
“It’s sort of a one-size-fits all approach to physicians who may or may not see many of these patients,” said Matt Mansell , the society’s director of government affairs.
Nine states currently have laws that require prescribers to check the database, although the details vary, Green said.
Puckett said he still hopes to craft a law that will increase use of the system, especially as statistics show that prescription drug abuse continues to plague the region.
The death toll from drug overdoses in Western Virginia reached a new high of 270 in 2011, according to the medical examiner, and illegal use of pain medications continues to be a problem in many regions, police reported at a recent summit meeting on prescription drug abuse.
For now, the emphasis seems to be on educating doctors about the program.
Over the past decade, there have been a number of improvements: The system is available around the clock, searches can include data from nine other states, and the information is available within seconds.
“There’s still a misconception out there by the prescribers that this is such a time-consuming process,” said Melton of One Care of Southwest Virginia.
“Physicians just don’t understand how easy of a process it can be.”
Weather JournalIcy mix moves in this Sunday AM