An evaluation of the development, implementation and outcome of a pilot prescription monitoring program in Newfoundland and Labrador

Doyle, Michael J. (2004) An evaluation of the development, implementation and outcome of a pilot prescription monitoring program in Newfoundland and Labrador. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Since the late 1980s, local medical professional associations, drug dependency groups, and the police had noted an apparent increase in the inappropriate clinical and illicit use of prescription medications in Newfoundland and Labrador. -- The Newfoundland Medical Board implemented a provincial government funded, province-wide, pilot Prescription Monitoring Program ("PMP") for narcotics and benzodiazepines in June 2000. Pharmacists electronically submitted batch prescription information to the Program. -- The purpose of this research was to analyze the policy process used to develop and implement the pilot PMP in comparison to a published guideline and to undertake a thorough clinical evaluation of this Program using a before/after study design. -- The Program did not impact the prescribing of program monitored drugs, identified substitutes, and the incidence of multiple doctoring as expected. However, increased break and enters at retail pharmacies after the Program was implemented suggested that these medications had become more difficult to access. Surveys of prescribing appropriateness indicated that the PMP might have positively impacted the prescribing of these drugs. However, various biases and a small sample size limited the ability to accurately determine the magnitude of the impact. Assessments of long-standing prescriptions that were abruptly discontinued suggested that the PMP did not adversely impact legitimate patient access to these medications. Most suspected drug-seeking patients reduced the number of physicians they visited. A small number increased their visits. A small number of physicians had prescribing volumes that exceeded ten times the mean. -- Numerous legal, budgetary, confidentiality and stakeholder participation problems hindered the Program's orderly implementation and its impact. Contrary to legislation, at least eleven pharmacies failed to report data. Some high prescribing physicians identified by the Province's drug subsidy program were located near these pharmacies. Professional regulatory groups appeared unable to accommodate the financial and legal risks necessary to address suspected inappropriate behavior among physicians, pharmacists and patients. -- Specifically targeted peer prescribing reports, academic detailing and regulatory sanctions were recommended to replace the PMP. A recommendation was made to forward the names of patients suspected of double doctoring to the police. The Province's drug subsidy and physician payment programs may suffice as a necessary future data source for specifically targeted interventions. Researchers concluded that the Program had a marginal positive impact.

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