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How Are Real-time Opioid Prescribing Cognitions by Emergency Providers Influenced by Reviewing the State Prescription Drug Monitoring Program?

OBJECTIVE
To understand how real-time opioid prescribing cognitions by emergency medicine (EM) providers are influenced by review of the state prescription drug monitoring program (PDMP).


METHODS
We collected prospective data from a convenience sample of 103 patient encounters for pain from 23 unique EM providers. After seeing the patient, before and immediately after reviewing the PDMP, EM providers answered how much they thought "the patient need[ed] an opioid to help manage their pain?", how concerned they were "about drug abuse and/or diversion?", and whether they planned to prescribe an opioid (yes/no). If they changed their decision to prescribe after querying the PDMP, they were asked to provide comments. We categorized encounters by opioid prescribing plan before/after PDMP review (e.g., O+/O- means plan changed from "yes" to "no") and examined changes in cognitions across categories.


RESULTS
Ninety-two of 103 (89.3%) encounters resulted in no change in opioid prescribing plan (61/92 [66.3%] O+/O+; 31/92 [33.7%] O-/O-). For the four O+/O- encounters, perceived patient opioid need decreased 75% of the time and concern for opioid abuse and/or diversion increased 75% of time. For the seven O-/O+ encounters, providers reported increased perceived patient opioid need 28.6% of the time and decreased concern for opioid abuse and/or diversion 14.3% of time.


CONCLUSIONS
PDMP data rarely alter plans to prescribe an opioid among emergency providers. When changes in opioid prescribing plan were made, this was reflected by changes in cognitions. Findings support the need for a properly powered study to identify how specific PDMP findings alter prescribing cognitions.