The Prescription Behavior Surveillance System: Applications of De-identified PDMP Data in

Public Health Surveillance

Rx Abuse SummitApril 23, 2014

Peter Kreiner, Ph.D.PDMP Center of Excellence at Brandeis University

The Prescription Behavior Surveillance System (PBSS)

A longitudinal, multi-state database of de-identified PDMP data, to serve as:

1. An early warning surveillance tool2. An evaluation tool, in relation to state and local

policies and initiatives, such as prescriber educational initiatives

PBSS Continued

Began in FY2012 with support from CDC and FDA, administered through BJAGuided by Oversight Committee:– Federal partners: CDC, FDA, BJA, SAMHSA– State partners to date: CA, DE, FL, ID, ME, OH – Additional 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

Committee approval

PBSS Continued

De-identified data from each participating state– Data use agreements tailored to each state’s laws and

requirements– Beginning with 2010 or 2011, initial 2 – 3 years of data– Data updated quarterly (including prior 12 months)– Project-specific ID #’s for patients, prescribers, pharmacies• Maintained for the duration of the data

– Data housed in secure IT environment at Brandeis University

PBSS Continued

Purpose (1): early warning public health surveillance tool– Periodic surveillance report with 40+ patient, prescriber, and

pharmacy measures– Help identify emerging trends, changes in prescription

patterns, indicators of risk associated with new drugs/new drug formulations

– Data dictionary and technical documentation– Development of standards in relation to data quality (error

rates, missing fields) and patient linking (determining which prescription records belong to the same patient)

– Online access for authorized federal researchers– Specialized analyses as agreed upon with each state partner

PBSS Continued

Purpose (2): evaluate selected initiatives to influence prescriber behavior – Inventory of state and local prescriber initiatives and

assessment of their evidence base• E.g., state mandates for prescribers to register with and use the

PDMP

– Development and validation of (population-level) measures of (in)appropriate and aberrant prescribing

– Evaluation of selected REMS trainings

Surveillance Data: Selected Examples• Opioid prescription rates by age group, comparison across

states• Number of Schedule II – V opioids per 1,000 state residents (in each

age group)

• Multiple provider episode rates by age group, comparison across states• Number of patients with prescriptions from 5 or more prescribers and

5 or more pharmacies in a 3-month period, per 100,000 state residents

• Multiple provider episode rates by quarter, 2010 – 2013 (Ohio)

• Multiple provider episode rates by community: Massachusetts

2012 Multiple Provider Episode Rates:Number of Patients with 5 or More Prescribers and 5 or More Pharmacies in 3 Months, per 1,000 Residents

Town Quintiles: Multiple Provider Episodes per 1,000 Residents00.01 - 0.290.29 - 0.440.44 - 0.680.68 - 1.97

Further Data Examples

• Proportion of total prescriptions accounted for by prescriber deciles: prescriber 10% groupings based on prescription volume

• Average daily opioid dosage (morphine milligram equivalents)

• Average daily opioid dosage by prescriber decile (based on volume of opioid prescriptions

Further Data Applications

• Community profiles based on PDMP measures• Inform local prevention and treatment needs assessment• Help evaluate local interventions/track community

progress in addressing prescription drug issues• Mass. PMP/Brandeis are developing community profiles

for: • BJA Data Sharing Pilot grantee (Norfolk County District

Attorney’s Office)• CSAP/Bureau of Substance Abuse Services grantees addressing

non-medical use of prescription drugs• BSAS block grant-funded grantees addressing opioid abuse

Further Data Applications, Continued• Versions of PBSS surveillance reports/measures for

PDMP constituencies:• Governor, legislators, other state agencies, consumer

groups, etc.

• Epidemiological analyses tailed to state needs• Examination of patient, prescriber, and dispenser behavior

over time: what earlier patterns are associated with (eventual) risk indications?

• E.g., patterns of risk indicators suggestive of collective activity, drug rings

• More detailed examination of prescribing patterns for children or elderly persons

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 prescription

records belong to the same patient

• An important part of PBSS is the development of methods to assess data quality and to assess the adequacy of prescription linking procedures

• And to assist PBSS states in implementing best practices for data quality and linking procedures, and processes for ongoing quality improvement

Contact Information

Peter Kreiner, Ph.D.Principal Investigator

PDMP Center of ExcellenceBrandeis University

781-736-3945pkreiner@brandeis.edu

www.pdmpexcellence.org