Prescription drug monitoring program (PDMP) utilization and outcomes within the West Palm Beach Veterans Affairs (VA) healthcare system

Objective: Prescription drug monitoring programs (PDMPs) can identify patients at risk of controlled substance (CS) polypharmacy and accidental poisoning.Design: A retrospective pre-/post-intervention review of a random sample of provider notes with documentation of PDMP outcomes was completed before and after the enactment of a Florida law mandating PDMP queries.Setting: West Palm Beach Veterans Affairs Health Care System, which provides inpatient and outpatient services.Participants: Reviewed a random sample of 10 percent of progress notes documenting PDMP outcomes between September and November 2017 and the same timeframe of 2018.Interventions: Florida enacted a law in March 2018 requiring PDMP queries to be completed for all new and renewed CS prescriptions.Main outcome measured: The primary outcome was to compare PDMP utilization and prescribing decisions based on query results before and after the enactment of the law.Results: The number of progress notes documenting PDMP queries increased by over 350 percent from 2017 to 2018. In 2017 and 2018, 30.6 percent (68/222) and 20.8 percent (164/790) of PDMP queries found non-Veterans Affairs (VA) CS prescriptions, respectively. Providers decided to avoid prescribing CS prescriptions in 23.5 percent (16/68) of patients with non-VA CS prescriptions found in 2017 and 11 percent (18/164) in 2018. Overlapping or unsafe combinations were identified in 10 percent (7/68) of queries with non-VA prescriptions found in 2017 and 14 percent (23/164) in 2018.Conclusions: Mandating PDMP queries resulted in an increase in the total number of queries, positive findings, and overlapping CS prescriptions. Outcomes of PDMP mandate impacted prescribing by discontinuation and avoidance of CS initiation in 10-15 percent of patients.