Statewide Screening: Narcotics Seeking Patients at Urgent Care Facilities

CIS 512

Trevor Rohm

Winter 2009

Introduction limited resources

busy, and at times overburdened

With prescription drug abuse statistics estimating that as much as 10% of the population

Visiting multiple facilities is known as “doctor shopping”

limited narcotics monitoring program

Project Goals Verify

− Those who require narcotics are not seeking treatment from multiple providers

− Screening through the state narcotic monitoring program

− Freeing valuable limited resources    

Design and implementation will focus on three key aspects: − People− Policy − Processes  

Attention Areas Phase 1: Information gathering

about current numbers of patients to screen               

Phase 2: Design and implementation of software interface with the state system               

Phase 3: Workflow evaluation, modifications and implementation               

Phase 4: Analysis and results

Limits− Primitive

experimental design to apply the intervention and then assess impact.  

− No sampling− No pretest− No control group− A count of the

number of suspected narcotic abusers, will serve as our measurement

− 3 different cities− 5 five urgent care

facilities − Healthcare system− Adult only− Exclude children − Exclude pregnant

women

Pitfalls

− Not randomized − No control group− Single intervention group  − Clinical providers rotate− Different patient

populations  indigent patients rural community large migrant population urban downtown setting new affluent community  

− They all serve unique populations, however, narcotic seeking patients have been known to frequent all 5 facilities, sometimes all in a single day.

Phase 1: Information Gathering Determine

− the total number of patient visits − total number of unique patients − the corresponding chief complaints for each visit

Count − number of patient visits− number of unique patients− number of visits per patient

Correlational study− number of times a patient presents to the Urgent Care − number of prescriptions (Rx) for narcotics given

Data plotted in 2 graphs.  One for # of Rx and the other for # of pills. 

Project implementation and resource allocation

Phase 2: Design and Evaluation

Current Narcotic Monitoring System− Requires pharmacies to upload

information for all narcotics prescriptions − Once a month− Batches may be uploaded online, sent by

magnetic tapes, CDs or by paper processes

− Single aggregate database

Project design will include a user-friendly, provider view of the state database

develop a real-time web-based system interface for Urgent Care facilities

Phase 3: Workflow Changes Necessary to involve the whole healthcare team:

− registration clerks− triage nurses− healthcare providers

Backup procedures system failure or internet outage

Policy so each team member can fulfill their job to capacity

Implementation must NOT limit healthcare providers nor interfere with their ability to care for patients

Information provided by the state can be used to help the provide care, however, it should never preclude prescribing additional medication if clinically indicated

Policy should never impede patient care and should always promote patient safety

Administration fully support project

Phase 4: Analysis and Results 12 months of data

Count of the number of Rxs for narcotics and the number of pills will be determined.

A correlational graph will be plotted

We will compute the following:− percentage of total visits by reported patients− the total number of narcotic Rxs provided these patients− the total number of pills provided these patients− the average number of pills per patient− the average number of Rxs per patient− the average number of visits per patient− average cost per visit (as determined by administrative data)− total cost for all potential drug seeking patients visits

Success by measuring the number of patients that have “pain” who are found to have received multiple narcotic prescriptions from various providers 

Data analysis can show how these costly resources can be

Conclusion Prescription narcotic drug abuse is common and Urgent

Care facilities are often frequented by these patients

By allowing the provider access to information kept by the state, drug seeking patients can be “weeded out” , thereby freeing resources and easing the burden on providers, at urgent care facilities throughout the state of New Mexico

Patient quality of care can be increased by allowing providers more time with patients in need and allow providers the ability to know what narcotic medications the patient is taking

Providing a means of screening for potential narcotic seeking patients can be another tool to aid providers in patient care, and save limited resources

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