1. PDMP
Track:
Prescrip/on
Behavior
Surveillance
System:
The
Value
and
Applica/ons
of
De-­‐iden/fied
PDMP
Data
in
Public
Health
Surveillance
Presenters:
Dr.
Peter
W.
Kreiner,
PhD,
PDMP
Principal
Inves7gator,
Prescrip7on
Drug
Monitoring
Program
Center
of
Excellence,
Brandeis
University
Mike
Small,
DOJ
Administrator,
Law
Enforcement
Support
Program,
CA
Department
of
Jus7ce
Moderator:
John
L.
Eadie,
Director,
Prescrip7on
Drug
Monitoring
Program
Center
of
Excellence,
Brandeis
University

2. Disclosures
• Dr.
Peter
W.
Kreiner
has
disclosed
no
relevant,
real
or
apparent
personal
or
professional
financial
rela8onships.
• Mike
Small
has
disclosed
no
relevant,
real
or
apparent
personal
or
professional
financial
rela8onships.

3. Learning
Objec/ves
1. Explain
the
value
and
applica8ons
of
de-­‐iden8fied
PDMP
data.
2. List
addi8onal
resources
for
op8mum
data
encryp8on
within
the
PDMP
program.
3. State
the
benefits
of
coordina8ng
interstate
data
sharing
and
the
barriers
that
currently
exist
to
limit
these
agreements.

4. The
Prescrip/on
Behavior
Surveillance
System:
Applica/ons
of
De-­‐iden/fied
PDMP
Data
in
Public
Health
Surveillance
Rx
Abuse
Summit
April
23,
2014
Peter
Kreiner,
Ph.D.
PDMP
Center
of
Excellence
at
Brandeis
University

5. The
Prescrip/on
Behavior
Surveillance
System
(PBSS)
A
longitudinal,
mul8-­‐state
database
of
de-­‐iden8fied
PDMP
data,
to
serve
as:
1. An
early
warning
surveillance
tool
2. An
evalua8on
tool,
in
rela8on
to
state
and
local
policies
and
ini8a8ves,
such
as
prescriber
educa8onal
ini8a8ves

6. PBSS
Con/nued
Began
in
FY2012
with
support
from
CDC
and
FDA,
administered
through
BJA
Guided
by
Oversight
CommiVee:
– Federal
partners:
CDC,
FDA,
BJA,
SAMHSA
– State
partners
to
date:
CA,
DE,
FL,
ID,
ME,
OH
– Addi8onal
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
CommiVee
approval

7. PBSS
Con/nued
De-­‐iden8fied
data
from
each
par8cipa8ng
state
– Data
use
agreements
tailored
to
each
state’s
laws
and
requirements
– Beginning
with
2010
or
2011,
ini8al
2
–
3
years
of
data
– Data
updated
quarterly
(including
prior
12
months)
– Project-­‐specific
ID
#’s
for
pa8ents,
prescribers,
pharmacies
• Maintained
for
the
dura8on
of
the
data
– Data
housed
in
secure
IT
environment
at
Brandeis
University

8. PBSS
Con/nued
Purpose
(1):
early
warning
public
health
surveillance
tool
– Periodic
surveillance
report
with
40+
pa8ent,
prescriber,
and
pharmacy
measures
– Help
iden8fy
emerging
trends,
changes
in
prescrip8on
paVerns,
indicators
of
risk
associated
with
new
drugs/new
drug
formula8ons
– Data
dic8onary
and
technical
documenta8on
– Development
of
standards
in
rela8on
to
data
quality
(error
rates,
missing
fields)
and
pa8ent
linking
(determining
which
prescrip8on
records
belong
to
the
same
pa8ent)
– Online
access
for
authorized
federal
researchers
– Specialized
analyses
as
agreed
upon
with
each
state
partner

9. PBSS
Con/nued
Purpose
(2):
evaluate
selected
ini8a8ves
to
influence
prescriber
behavior
– Inventory
of
state
and
local
prescriber
ini8a8ves
and
assessment
of
their
evidence
base
• E.g.,
state
mandates
for
prescribers
to
register
with
and
use
the
PDMP
– Development
and
valida8on
of
(popula8on-­‐level)
measures
of
(in)appropriate
and
aberrant
prescribing
– Evalua8on
of
selected
REMS
trainings

10. Surveillance
Data:
Selected
Examples
• Opioid
prescrip8on
rates
by
age
group,
comparison
across
states
• Number
of
Schedule
II
–
V
opioids
per
1,000
state
residents
(in
each
age
group)
• Mul8ple
provider
episode
rates
by
age
group,
comparison
across
states
• Number
of
pa8ents
with
prescrip8ons
from
5
or
more
prescribers
and
5
or
more
pharmacies
in
a
3-­‐month
period,
per
100,000
state
residents
• Mul8ple
provider
episode
rates
by
quarter,
2010
–
2013
(Ohio)
• Mul8ple
provider
episode
rates
by
community:
MassachuseVs

15. Further
Data
Examples
• Propor8on
of
total
prescrip8ons
accounted
for
by
prescriber
deciles:
prescriber
10%
groupings
based
on
prescrip8on
volume
• Average
daily
opioid
dosage
(morphine
milligram
equivalents)
• Average
daily
opioid
dosage
by
prescriber
decile
(based
on
volume
of
opioid
prescrip8ons

20. Further
Data
Applica8ons
• Community
profiles
based
on
PDMP
measures
• Inform
local
preven8on
and
treatment
needs
assessment
• Help
evaluate
local
interven8ons/track
community
progress
in
addressing
prescrip8on
drug
issues
• Mass.
PMP/Brandeis
are
developing
community
profiles
for:
• BJA
Data
Sharing
Pilot
grantee
(Norfolk
County
District
AVorney’s
Office)
• CSAP/Bureau
of
Substance
Abuse
Services
grantees
addressing
non-­‐medical
use
of
prescrip8on
drugs
• BSAS
block
grant-­‐funded
grantees
addressing
opioid
abuse

21. Further
Data
Applica8ons,
Con8nued
• Versions
of
PBSS
surveillance
reports/measures
for
PDMP
cons8tuencies:
• Governor,
legislators,
other
state
agencies,
consumer
groups,
etc.
• Epidemiological
analyses
tailed
to
state
needs
• Examina8on
of
pa8ent,
prescriber,
and
dispenser
behavior
over
8me:
what
earlier
paVerns
are
associated
with
(eventual)
risk
indica8ons?
• E.g.,
paVerns
of
risk
indicators
sugges8ve
of
collec8ve
ac8vity,
drug
rings
• More
detailed
examina8on
of
prescribing
paVerns
for
children
or
elderly
persons

22. 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
prescrip8on
records
belong
to
the
same
pa8ent
• An
important
part
of
PBSS
is
the
development
of
methods
to
assess
data
quality
and
to
assess
the
adequacy
of
prescrip8on
linking
procedures
• And
to
assist
PBSS
states
in
implemen8ng
best
prac8ces
for
data
quality
and
linking
procedures,
and
processes
for
ongoing
quality
improvement

23. Contact
Informa/on
Peter
Kreiner,
Ph.D.
Principal
Inves8gator
PDMP
Center
of
Excellence
Brandeis
University
781-­‐736-­‐3945
pkreiner@brandeis.edu
www.pdmpexcellence.org