Capsule Commentary on Radomski et al.’s Physicians’ Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-state Qualitative Study
Capsule Commentary on Radomski et al.'s Physicians' Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-state Qualitative Study
Mark W. Vander Weg
Ph.D. 0 1 2
0 Department of Psychological and Brain Sciences, University of Iowa , Iowa City, IA , USA
1 Department of Internal Medicine, University of Iowa , Iowa City, IA , USA
2 Iowa City VA Health Care System , Iowa City, IA , USA
A of opioids prescribed in the USA, their use remains
lthough progress has been made in reducing the amount
widespread. To effectively address the morbidity and mortality
associated with these medications, fundamental changes to the
way that we approach their use are needed.
One approach receiving increased attention is the use of
Prescription Drug Monitoring Programs (PDMPs).
PDMPs are statewide databases that track the prescribing
and dispensing of controlled substances and that are
designed to help prescribers and other stakeholders identify
and prevent their misuse. Although evaluations of their
impact have yielded mixed results, accumulating evidence
suggests that state PDMPs with robust features including
strong mandates regarding registration and use are
associated with reductions in opioid prescribing2 and overdose
Unfortunately, PDMPs remain greatly underutilized,4 which
substantially undermines their potential impact. To help
understand why, Radomski et al.1 investigated the Department of
Veterans Affairs (VA) physicians’ perspectives regarding
PDMPs. Primary care providers from states with differing
levels of prescriber access to PDMPs were interviewed
regarding their experiences with PDMPs as well as barriers and
facilitators to their use. Although support for PDMPs was
widespread, difficulties accessing key information and
significant administrative burdens were noted. Limited availability
of VA prescription data in state PDMPs was also viewed as
problematic. Linking PDMPs to the electronic medical record
(EMR), access to note templates to facilitate documentation,
and the ability to delegate routine queries to ancillary staff
were identified as desired modifications to enhance usability.
Radomski et al.’s1 rigorous qualitative approach allowed for
a greater understanding of factors influencing prescribers’
PDMP use. Their findings are consistent with prior work
suggesting that access difficulties are prominent barriers to
their use.4, 5 Although linking PDMPs to the EMR may raise
concerns about information security, it is encouraging that the
proposed solutions are feasible and apply to both VA and
When designed correctly and used consistently, PDMPs
hold considerable promise for improving prescribing practices
and reducing patient risk. If PDMPs are to fulfill their full
potential, steps to facilitate their use such as those identified by
Radomski et al.1 are needed.
Compliance with ethical standards:
Conflict of interest: The author declares that he has no conflict of
1. Radomski TR , Bixler FR , Zickmund SL , Roman KM , Thorpe CT , Hale JA , Sileanu FE , Hausmann LRM , Thorpe JM , Suda KJ , Stroupe KT , Gordon AJ , Good CB , Fine MJ , Gellad WF . Physicians' Perspectives Regarding Prescription Drug Monitoring Program Use within the Department of Veterans Affairs: A Multi-State Qualitative Study . J Gen Intern Med . DOI: https://doi.org/10.1007/s11606-018-4374-1.
2. Wen H , Shackman BR , Aden B , Bao Y. States with Prescription Drug Monitoring Mandates Saw a Reduction in Opioids Prescribed to Medicaid Enrollees . Health Affairs . 2017 ; 36 ( 4 ): 733 - 41 .
3. Patrick SW , Fry CE , Jones TF , Buntin MB . Implementation of Prescription Drug Monitoring Programs Associated with Reductions in Opioidrelated Death Rates . Health Affairs . 2016 ; 35 ( 7 ): 1324 - 32 .
4. Rutkow L , Turner L , Lucas E , Hwang C , Alexander GC . Most Primary Care Physicians are Aware of Prescription Drug Monitoring Programs, but Many Find the Data Difficult to Access . Health Affairs. 2015 ; 34 ( 3 ): 484 - 92 .
5. Poon SJ , Greenwood-Ericksen MB , Gish RE , Neri PM , Takhar SS , Weiner SG , Schuur JD , Landman AB . Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study . Acad Emerg Med . 2016 Apr; 23 ( 4 ): 406 - 14 .