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. 2023 Jul 1:248:109896.
doi: 10.1016/j.drugalcdep.2023.109896. Epub 2023 Apr 26.

Impact of unsolicited reporting notifications on providers' prescribing behavior: An experimental study on Maryland PDMP data

Masoumeh Amin-Esmaeili  1 , Rachel Alinsky  2 , Renee M Johnson  3 , Anna Gribble  4 , Natasha Oyedele  3 , Taylor Parnham  5 , Lindsey Goddard  4 , Ryoko Susukida  3
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Impact of unsolicited reporting notifications on providers' prescribing behavior: An experimental study on Maryland PDMP data

Masoumeh Amin-Esmaeili et al. Drug Alcohol Depend. .

Abstract

Background: Unsolicited Reporting Notifications(URNs) have been a component of Maryland's Prescription Drug Monitoring Program (PDMP) since 2016. We evaluated the effect of URNs on providers' prescription behaviors.

Methods: This is a quasi-experimental study of providers who were issued at least one URN from January 2018 to April 2021. Providers for whom URNs were not successfully delivered were designated as a comparison group. The outcome variables were average daily opioid and benzodiazepine prescriptions, average morphine milligram equivalents per patient, and proportion of overlapping opioid and benzodiazepine, either with or without muscle relaxant prescriptions. Changes were compared before versus after the issuance of a URN among the intervention and comparison groups using "Generalized Estimation Equation" and "Generalized Linear" Models. We also conducted stratified analyses by types of URN, including notifications for multiple provider episodes (MPE), overdose fatality (ODF), and dangerous drug combinations (DDC).

Results: The average daily number of opioids prescriptions (3.3% decrease in the intervention group vs 22.7% increase in the comparison group, P<0.001), co-prescription of opioids and benzodiazepines either with muscle relaxants (68.0% decrease vs. 36.1% decrease, P<0.001), or without muscle relaxants (6.0% decrease vs. 16.3% increase, P<0.001), significantly reduced after the first URN regardless of the type of URN. Stratified analysis by types of URNs showed that ODF and DDC URNs had a significant effect on most of the outcomes of interest.

Conclusion: The findings suggest that unsolicited reporting, especially particular types of URNs including ODF and DDC, is associated with subsequent changes in unsafe prescribing behaviors.

Keywords: Inappropriate opioid prescription; Opioid overdose; Prescription Drug Monitoring Programs; Prescription drug abuse; Unsolicited reporting notification.

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Conflict of interest statement

Declaration of Competing Interest Anna Gribble was the Provider Engagement and Policy Manager with the Maryland Department of Health (MDH) at the time of data analysis and drafting the report. She worked in the Office of Provider Engagement and Regulation (OPER) and she was responsible for PDMP programmatic activities and policies. Lindsey Goddard is an Epidemiologist. She also works in the Office of Provider Engagement and Regulation (OPER) and she is responsible for data analysis and management for the PDMP. Her staff time is supported by the Maryland Overdose Data to Action Cooperative Agreement from CDC and FY 2020 Harold Rogers Grant, DOJ, BJA. All other authors have no competing interest to declare.

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