the prescription behavior surveillance system: applications of de-identified pdmp data in public...
TRANSCRIPT
The Prescription Behavior Surveillance System: Applications of De-identified PDMP Data in
Public Health Surveillance
Rx Abuse SummitApril 23, 2014
Peter Kreiner, Ph.D.PDMP Center of Excellence at Brandeis University
The Prescription Behavior Surveillance System (PBSS)
A longitudinal, multi-state database of de-identified PDMP data, to serve as:
1. An early warning surveillance tool2. An evaluation tool, in relation to state and local
policies and initiatives, such as prescriber educational initiatives
PBSS Continued
Began in FY2012 with support from CDC and FDA, administered through BJAGuided by Oversight Committee:– Federal partners: CDC, FDA, BJA, SAMHSA– State partners to date: CA, DE, FL, ID, ME, OH – Additional state partners in process (IN, KY, WA)– Adjunct state partners (MA, OK, TN) – unable to share data
but willing to provide PBSS surveillance measures– No release of data or findings without Oversight
Committee approval
PBSS Continued
De-identified data from each participating state– Data use agreements tailored to each state’s laws and
requirements– Beginning with 2010 or 2011, initial 2 – 3 years of data– Data updated quarterly (including prior 12 months)– Project-specific ID #’s for patients, prescribers, pharmacies• Maintained for the duration of the data
– Data housed in secure IT environment at Brandeis University
PBSS Continued
Purpose (1): early warning public health surveillance tool– Periodic surveillance report with 40+ patient, prescriber, and
pharmacy measures– Help identify emerging trends, changes in prescription
patterns, indicators of risk associated with new drugs/new drug formulations
– Data dictionary and technical documentation– Development of standards in relation to data quality (error
rates, missing fields) and patient linking (determining which prescription records belong to the same patient)
– Online access for authorized federal researchers– Specialized analyses as agreed upon with each state partner
PBSS Continued
Purpose (2): evaluate selected initiatives to influence prescriber behavior – Inventory of state and local prescriber initiatives and
assessment of their evidence base• E.g., state mandates for prescribers to register with and use the
PDMP
– Development and validation of (population-level) measures of (in)appropriate and aberrant prescribing
– Evaluation of selected REMS trainings
Surveillance Data: Selected Examples• Opioid prescription rates by age group, comparison across
states• Number of Schedule II – V opioids per 1,000 state residents (in each
age group)
• Multiple provider episode rates by age group, comparison across states• Number of patients with prescriptions from 5 or more prescribers and
5 or more pharmacies in a 3-month period, per 100,000 state residents
• Multiple provider episode rates by quarter, 2010 – 2013 (Ohio)
• Multiple provider episode rates by community: Massachusetts
2012 Multiple Provider Episode Rates:Number of Patients with 5 or More Prescribers and 5 or More Pharmacies in 3 Months, per 1,000 Residents
Town Quintiles: Multiple Provider Episodes per 1,000 Residents00.01 - 0.290.29 - 0.440.44 - 0.680.68 - 1.97
Further Data Examples
• Proportion of total prescriptions accounted for by prescriber deciles: prescriber 10% groupings based on prescription volume
• Average daily opioid dosage (morphine milligram equivalents)
• Average daily opioid dosage by prescriber decile (based on volume of opioid prescriptions
Further Data Applications
• Community profiles based on PDMP measures• Inform local prevention and treatment needs assessment• Help evaluate local interventions/track community
progress in addressing prescription drug issues• Mass. PMP/Brandeis are developing community profiles
for: • BJA Data Sharing Pilot grantee (Norfolk County District
Attorney’s Office)• CSAP/Bureau of Substance Abuse Services grantees addressing
non-medical use of prescription drugs• BSAS block grant-funded grantees addressing opioid abuse
Further Data Applications, Continued• Versions of PBSS surveillance reports/measures for
PDMP constituencies:• Governor, legislators, other state agencies, consumer
groups, etc.
• Epidemiological analyses tailed to state needs• Examination of patient, prescriber, and dispenser behavior
over time: what earlier patterns are associated with (eventual) risk indications?
• E.g., patterns of risk indicators suggestive of collective activity, drug rings
• More detailed examination of prescribing patterns for children or elderly persons
A Concluding Note
• Increasing use of PDMP data highlights a need for data quality and data consistency• States vary in measures to ensure and improve data quality• States vary in procedures to determine which prescription
records belong to the same patient
• An important part of PBSS is the development of methods to assess data quality and to assess the adequacy of prescription linking procedures
• And to assist PBSS states in implementing best practices for data quality and linking procedures, and processes for ongoing quality improvement
Contact Information
Peter Kreiner, Ph.D.Principal Investigator
PDMP Center of ExcellenceBrandeis University
www.pdmpexcellence.org