Prescription Abuse Prevention Workgroup update

Stakeholder updates CJOW Workgroup 4/17/19

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Prescription Abuse Prevention Workgroup update State Opioid Response Plan, Goal 1: Prevent opioid misuse and abuse Opioid Response Workgroup Quarterly Meeting – July 18, 2019 Strategy 1.1: Prevent misuse in communities, particularly among youth.

• 23 high-need communities are funded by HCA/DBHR through the State Opioid Response grant to implement the Community Prevention and Wellness Initiative (CPWI), a model that creates coalition-driven work to address substance use, and opioid misuse, in communities. These communities have completed a six-month strategic planning process to identify the substance use needs to prevent opioid misuse and abuse among youth and community members.

• Prevention grants to community-based organizations, education partners, and other partners: HCA/DBHR funds high-need communities to provide direct prevention services to prevent substance use in communities. The State Opioid Response grant funded 9 additional sites to implement evidence-based programs, such as Life Skills Trainings and Positive Action for students, Strengthening Families for parents, and provide awareness activities such as promotion of the National Drug Take Back Days to reduce the amount of opioids and medication in households.

o HCA/DBHR will open an RFA this Fall for additional community-based organization grants to address opioid misuse and abuse prevention in communities.

• DOH IVP manages prevention activities currently with 2 CDC grants which will end on August 31, 2019. Activities include:

o Fund 9 community local health jurisdictions (LHJs) and the Southwest Accountable Community of Health (SWACH) to connect people who experience overdoses with substance use disorder (SUD) treatment, provide public education and provider training, increase local data collection, create public dashboards, and implement intervention strategies uniquely tailored to the county’s needs. [Clallam, Grays Harbor, King, Mason, Okanogan, Pierce, Skagit, Snohomish, and Spokane.] Recent highlights include:

o SWACH – supports a peer provider with shared Hepatitis C treatment experience to deliver support consistent with the nationally recognized peer support model of care. The peer-provider is integrated into Hep C clinical treatment setting where they meet and provide program support to SUD patients.

o Okanogan County is conducting county-wide qualitative survey on community perception of SUD issues and available resources. By May 2019, they received ~900 responses. Recently the county formalized an agreement with Colville Tribal stakeholders to distribute the survey to Tribal members living on the reservation.

o Snohomish County hosted a table top exercise to discuss mass fatality county-wide planning to determine possible processes and implications if fentanyl overdose-related mass fatality were to occur in the county.

• Prevention grants to Tribes: Twenty six of the 29 federally recognized Tribes in WA State access DBHR grants to address Opioid Use Disorders with 18 of the 26 Tribes using some or all funds for prevention activities. The Tribes have been using OUD grants to support prevention efforts to implement programs such as Healing of the Canoe, Canoe Journey, Gathering of Native Americans, American Indian Life Skills, lockbox distribution and many other cultural programs. One success story is that the Samish Tribe has been successfully handing out over 300 secure medicine locking bags in their community and hosting overdose prevention trainings.

Prescription Abuse Prevention Workgroup Workgroup Leads: Jaymie Mai and Alicia Hughes 07/15/19

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Strategy 1.2: Opioid prescribing practices • Opioid prescribing rules/Bree Collaborative/Agency Medical Directors Group:

o L&I, Bree Collaborative and North Central Accountable Community of Health sponsored a Dental Opioid Prescribing Workshop in Wenatchee on May 3. This 1/2 day conference was well attended by 61 dental providers in the community 98% of attendees would recommend this conference to their colleagues

o The Bree Collaborative Opioid Workgroup is drafting guidance for providers on assessing and developing a patient-centered approach to pain management for patients on chronic opioid therapy.

o The AMDG, Bree Collaborative and Region 10 Opioid Summit co-sponsored the August 9th Patient-Centered Approach to Chronic Opioid Management conference This one-day conference will share emerging understanding about pain care from

statewide and national experts Primary care providers will learn the latest evidence for assessing and managing patients

on chronic opioids, how primary care providers engage patients in clinical pathways that support safe and effective pain treatment, real pain care innovations used in health care organizations, best practices for determining whether patients on chronic opioids are benefiting or are being harmed and whether to taper or treat opioid use disorder and much more!

Providers can earn up to 7.5 AMA PRA Category 1 Credit(s)™ for a low fee of $75. Also, this CME would be recognized by the Nursing Commission for nurses.

Registration is still opened, so act quickly and register at https://www.eiseverywhere.com/ereg/index.php?eventid=450709&

• Technical assistance/coaching to providers: HOT ISSUE - Hearing from providers and patients on 1427 opioid prescribing rules mis-interpretations. Quote from provider, “We need to taper as fast as possible or DOH will come after our license.” Better education around the new rules and support for providers to continue to serve their patients in need.

• DOH IVP manages the following activities through the CDC Prevention for States (PfS) grant: o The Washington State Department of Health, University of Washington and Washington State

University jointly offered a 15 week Certified Addictions Nursing course for nurses in primary care. The course ended in June and the first cohort was very successful. More than 250 signed up for the course, overwhelming capacity, only 50 were accepted. The course was recorded and materials are freely available for others to use. DOH plans to host the materials in the future.

o Washington State University – Interdisciplinary Module – extension of their inter-professional education program with opioid use intro training for rural clinics in Washington State.

o Important request: Currently the team is looking for rural primary care clinics that might be willing to partner, adapt and pilot the 2-hour program. The clinics will benefit from the training in that it provides a chance to assess how their opioid prescribing practices align with current standards and how well behavioral health and coordination with addiction services has been integrated. Ultimately, we expect provider’s confidence and satisfaction in the care of populations requesting opioids can be improved through the course, as well as improved patient outcomes.

o Public Health Nurse provides education and technical assistance. Mary Catlin retired June 2019, Dan Otter is DOH’s new public health nurse working on opioids. [email protected] 1427 prescriber training and review of rules - Grays Harbor, Summit Pacific Medical

Center. Visited with LHJ and SSP site visit to discuss needs in Grays Harbor. Met with Greg Miller to discuss status of ED to treatment work in Washington State and

share information from other EDs on issues and recommendations they are seeing. Met with state health officer and emergency preparedness to discuss how to modify

emergency protocol for state role in the event of multiple overdose event. Worked with CSTE intern who is presenting this data at Western Regional Epidemiologic Conference.

https://www.eiseverywhere.com/ereg/index.php?eventid=450709&


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o Physician Speakers - DOH has supported seven providers to teach 14 buprenorphine courses this year. Providers who teach courses have been amazing champions to increase buprenorphine providers in WA. In 2019, 407 buprenorphine waivers have been issued in Washington.

• Higher education curriculum: WSU College of Nursing has found a rural clinic willing to pilot test the IPE curriculum – this is funded by DOH to train health science students. WSU was also notified that they received a $1.9 million HRSA grant starting July 1 to extend this work across Washington State. They will be looking for more clinics to partner for IPE education. The program will include an assessment of their current practices regarding opioid prescribing and a training to help build teams.

Strategy 1.3: Prescription Monitoring Program • Increase use of PDMP: See attachment included in this packet. • Share data with prescribers:

o L&I sent 247 opioid prescribing report in April to network providers with high risk prescribing to ensure that opioid prescribing best practices are followed and injured workers are receiving safe and effective care

Strategy 1.4: Educate the public about risks of opioid use, including overdose • Educate patients about best practices:

o HCA/DBHR continues to explore options for Prescriber Education this coming year to continue educating our community members and providers about efforts for opioid misuse and abuse. We will be getting involved with the SHAPE Conference again this year. The mission of SHAPE Washington supports coordinated efforts to foster healthy, active, educated, youth in Washington State through professional development, advocacy, community outreach, and partnerships. Our goal is to bring education to PE Teachers and Coaches about their role with changing students' behaviors around pain/using opioids.

o HCA/DBHR is currently planning the Region 10 Opioid Summit to provide education and open dialogue with state, tribal, behavioral health, medical providers, and community providers in an effort to reduce opioid use disorder. The Summit will be held in partnership with Idaho, Alaska, and Oregon. This will be held in August 6-9, 2019 in Vancouver, WA. There will be a specific component to include interventions such as naloxone, harm reduction, and other topics that support the continuum of prevention, treatment, and recovery. DBHR is putting together a broader planning group and individual subgroups at this time for the coordination of breakout sessions and speakers. We will also ensure that populations such as rural communities, criminal justice, and tribal communities have representation within presentations and/or panels.

• Implement public education campaigns: o HCA/DBHR is continuing expansion of the Starts with One opioid prevention campaign, geared

for audiences of young adults, parents, and older adults. The campaign can be found at www.getthefactsrx.com. We have created provider toolkits that can be used for outreach to healthcare providers, pharmacy bags that have been distributed to pharmacies in 19 counties, and a plethora of materials for dissemination to communities.

o CDC RX awareness campaign running through the summer of 2019. This is a prescription drug awareness campaign highlighting the dangers of addiction and overdose. Primary focus on rural counties with limited or no funding for educational campaigns. Translating some materials into Spanish, reaching the Spanish speaking and Latinx communities. Will also focus efforts with black communities as data shows an increase in overdose deaths in these populations. Coordinated target areas with the HCA Starts With One campaign.

http://www.getthefactsrx.com/


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Strategy 1.5: Home safe storage and disposal • Education on storage and disposal: Preliminary discussions with the communications teams at DOH and

HCA about how we might promote the program. Still early in the process so we won’t be focusing on the education piece until we are closer to have an operating program.

• Implement the WA Secure Drug Take Back Act HB 1047: Rules for chapter 69.48 RCW were filed on July 1, 2019 (chapter 246-480 WAC). One plan proposal was received from a potential program operator (Med-Project) on July 1, 2019. Med-Project runs all the programs at the county level in Washington State which will hopefully help ensure a smooth transition as the program is brought to scale and, after the initial 12 months of operating, a smooth transition as the counties with existing programs are folded into the statewide program. DOH has 120 days to review the plan and either approve or reject it.

Strategy 1.6: Decrease supply of opioids. • Engage stakeholders for policies to eliminate paper prescriptions:

o Two stakeholder meetings held o Federal and State law will require transmission of controlled substance prescription by 1/1/2021 o Pharmacy Commission drafting a summary memo o Suggest reevaluating after in place for one year

• Suspicious orders criteria: o Two stakeholder meetings held o Follow up work with distributor association to identify other state actions o Reviewing National Association of Boards of Pharmacy Report o Will plan additional stakeholder meeting to discuss draft criteria and recommendations.

• Medicaid Fraud Unit investigations: o Medicaid Fraud Control Unit (MFCU) has the authority to investigate through final CMS rule

changes (effective May 21, 2019). MFCU is working with law enforcement on suspicious cases. • Drug gang task forces:

o There is funding in the Governor’s FY2020 budget for a drug trafficking taskforce.

For more information Contact the Workgroup Co-Leads:

Alicia Hughes, MA, CPP Strategic Development and Policy Unit Supervisor SUD Prevention and MH Promotion Section Division of Behavioral Health and Recovery office: 360-725-1687 | cell: 360-742-6403 [email protected] Jaymie Mai, Pharm.D. Pharmacy Manager Department of Labor & Industries P: 360-902-6792 E: [email protected]

mailto:[email protected]


Updates for Goal 1 Workgroup – July 10, 2019

WA PRESCRIPTION MONITORING PROGRAM

WA State DOH | 2

Engrossed Substitute House Bill 1427 (2017)

• Required Development of opioid prescribing rules– 5 Boards and Commissions

• Expands authority and access to use PMP data– Assessment of prescribing and morbidity/mortality data– Prescriber feedback reports / reports to provider groups– Overdose follow up by local health officers– Federal and tribal facilities– Overdose notification via the Emergency Department

Information Exchange– WSHA Coordinated Quality Improvement Program

Presenter

Presentation Notes

Engrossed Substitute House Bill (ESHB) 1427 was passed by the 2017 Washington legislature to impact Washington’s ongoing epidemic of opioid misuse and overdose. Among other changes the bill required the development of new opioid prescribing rules by the boards and commissions that oversee the 5 prescribing professions and expanded authorization for using PMP data to support public health objectives, overdose notification, overdose follow up and quality improvement.

WA State DOH | 3

PMP Registration

A workgroup of subject matter and technical experts from the Department of Health, Washington Technology Solutions (WaTech) and the Office of Cyber Security are gathering feedback and evaluating options in collaboration with providers and professional associations that meet our shared goals of security and patient safety. We must develop solutions that effectively balance the need for security with ease of use to support provider use of the PMP in Washington.

www.doh.wa.gov/PMPEaseofUseImprovements:

- Refined web access to PMP information and resources (one path)

- Provided information and education to help healthcare facilities improve access

- DOH-PMP Helpdesk provided extended hours during use mandates implementation

Ease of Use Project (2018)

Presenter

Presentation Notes

Ease of Use Project: The PMP Ease of Use Project focused on reducing the time and burden healthcare providers face to access the PMP single sign on portal ta while ensuring the level of security required by Washington’s CIO for category 4 data (personally identifiable information and personal healthcare information). Access to the PMP is protected under RCW 70.225 restricting access to licensed healthcare providers in two categories and further protected by state data security laws requiring the use of two-factor authentication to access this category of data. Registrants are required to complete an identity verification process (KBA) as well as establish personal contact information for Multi-Factor Authentication ensuring only authorized users may gain access to PMP data. Once the registrant has completed the SAW/PMP registration process, the user will receive a security challenge at every log-on attempt for the first few days, this challenge take roughly a minute or so to complete. The MFA security protocol will stop prompting the user to complete the 6 digit pin security challenge once it has developed a secure relationship with the user’s I.P address. Once this level of trust is achieved the log-on time will be cut down to an estimated 20-30 second timeframe, drastically reducing the time spent interacting with the system which allows for more time to focus on patient care. Prescribers and Pharmacy staff have come to have a great appreciation for the reduced time spent interacting with the SAW/PMP systems. User’s that maintain a regular log-on history find the changes made through the ease of use project to be time saving and user friendly.

http://www.doh.wa.gov/PMPEaseofuse

WA State DOH | 4

HEALTH CARE PROVIDER ACCOUNT REGISTRATIONS

Presenter

Presentation Notes

Active provider accounts increased during opioid prescribing rule implementation from 25,507 in November 2018 to 32,808 in April 2019 for a growth of 28.6 % Opioid Prescribing Rule Implementation Dates: Podiatry, Osteopathic, Nursing – November 2018 Medical – January 2019 Dental January 2019 Delegate accounts increased respectively to the growth of provider accounts due to rules requirements of each Board and Commission (See slide 5). More information on Opioid Prescribing Rules is available at www.doh.wa.gov/OpioidPrescribing

Delegate Accounts for Prescribers

• The rule allows for “licensed health care practitioner authorized by a prescriber” to access information as a delegate

• Any health professional licensed by the department can have a delegate account.

• Same registration process for the delegate.

• Prescribers manage (link and un-link) delegate accounts to their main account to make requests on their behalf

Delegates are able to access the system and check patient records on behalf of the prescriber

Presenter

Presentation Notes

Opioid Prescribing Rule Implementation Dates: Podiatry, Osteopathic, Nursing – November 2018 Medical – January 2019 Dental January 2019 Delegate accounts increased respectively to the growth of provider accounts due to rules requirements of each Board and Commission.

WA State DOH | 6

HEALTH CARE PROVIDER ACCOUNT REGISTRATIONS

Presenter

Presentation Notes

Data Tables > PMP – Active Accounts As you can see Provider Delegate accounts increased by roughly 1,400 registrations while Provider Master accounts increased by an estimated 3,400 from Nov 2018 to Mar 2019 due to the implementation of the Boards and commissions mandatory use rules. Pharmacy Master and Delegate accounts experienced a minor growth of 200 / 18 registrations respectively. These minor growths cannot be directly connected to the new use requirements, but it is safe to assume it is a byproduct of corps. being proactive and predicting desires. The established growth since the rules change has been 7,301 new registrations, 5,018 of those can be contributed to the mandatory use rules going into effect. The remaining 2,283 new registrations were submitted by persons not affected by the rules change i.e. out of state providers, veterinary professionals and DoD medical personnel ( many of which are licensed out of state)

WA State DOH | 7

Compliance

All pharmacies licensed in the state of Washington to dispense Schedule II, III, IV, and V controlled substances, and any other drugs identified by the Board of Pharmacy as demonstrating a potential for abuse, are required to collect and report their dispensing information. RCW 70.225.020 requires each dispenser to submit their information to the Department of Health. RCW246-480-030 states, a dispenser shall submit data to the department electronically, not later than one business day from the date of dispensing, and in the format required by the department (ASAP 4.2).

Presenter

Presentation Notes

WA PMP staff audits all controlled substance data uploads weekly to ensure all submissions are conducted in a timely manner ( minimum of 4 reports covering 7 days CS data). On average, the PMP receives daily reports from an estimate 1500 separate pharmacies. Out of those 1500 pharmacies roughly 15-30 instate pharmacies and 20-30 out of state pharmacies fail to submit records in a timely manner each week. Those pharmacies are contacted via email first then by phone if the first attempt fails to inform the P.I.C of the deficiency, Pharmacy’s are given a week to report any missing data for the week stated in the communication. Failure to comply may result in a request for a formal investigation into the matter.

WA State DOH | 8

Not Required to Submit Data

• Licensed wholesalers, distributors, manufacturers• Rx’d for < 24hrs or directly administered• Prescriptions provided to patients receiving inpatient care at

hospitals• Pharmacies operated by the Department of Corrections

• Except when an offender is released with a dispensing intended for > 24 hrs of use

• Federally operated facilities• Veterans Affairs, Department of Defense or other federally

operated pharmacies• Voluntary reporting from Indian Health Service (IHS) & Veterans

Affairs (VA) since 2015• Opioid Treatment Programs (42CFR)

Presenter

Presentation Notes

The PMP does not contain record of all controlled substances used, there are a few cases where controlled substances are not required to be reported to PMP. Federal entities, including Indian Health Services (IHS) are governed by federal law and are not bound to state requirements. IHS and VA have been voluntarily submitting data since 2014 and 2015 respectively. Treatment and Methadone Programs are prevented/restricted from reporting under 42-CFR

WA State DOH | 9

Interstate Data Sharing

Interstate data sharing refers to the ability to request data from other states via the home state (WA PMP) system

WA is now connected to 2 interstate data sharing hubs providing this ability with over 20 other states.

• Functionality is available via SSP only currently

Next Steps: Incorporation of interstate data sharing into existing Electronic Health Records system (EHR) integrations via Washington’s Health Information Exchange (HIE)

Presenter

Presentation Notes

The Washington PMP has connected to two interstate data sharing hubs to provide the ability to query other state’s PMP system from within the WA system. In many cases this means providers will not have to access multiple systems to query their patients across multiple states.

WA State DOH | 10

Overdose Notifications

• In a study of 2,848 commercially insured patients aged 18 to 64 years who had a nonfatal opioid overdose during long-term opioid therapy for noncancer pain between May 2000 and December 2012 found that opioids were dispensed to 91% of patients after an overdose.

• A California study found 170 patients who suffered fatal overdoses had received opioid prescriptions from five prescribers on average. Increased awareness and timely alerts resulted in fewer new opioid prescriptions and fewer high-dose prescriptions.

• In 2016, there were 694 overdose deaths in Washington. These deaths represent a tragic loss of life. We can decrease overdose deaths.

Presenter

Presentation Notes

Non-fatal opioid overdose is a key predicting indicator of future opioid overdose and death.

WA State DOH | 11

Overdose Notifications

In 2017, WSHA, WSMA and DOH collaborated on HB 1427, which established an overdose event notification system. This system, uses the existing infrastructure of the Emergency Department Information Exchange (Edie) system and is intended to provide clinicians with meaningful information to help stop overdose deaths.

• Pilot began in October 2018 in the Olympic region (ACH)• Working with ACHs to expand through SW WA, Central WA and state wide

Presenter

Presentation Notes

ESHB 1427 required the development of an overdose notification system using Washington’s existing Emergency Department Information Exchange (EDIE) system. EDIE has been providing WA PMP data to providers in the ED since 2014 using a connection with Washington’s Health Information Exchange (HIE) and is well established in the provider community. Re-use of this existing infrastructure to provide overdoes notifications saved time, money and resources. The PMP is working with WSHA, WSMA, Collective Medical and Washington Accountable Communities of Health (ACH) to educate providers in each region about this opportunity and how they can opt-in to participate.

How it works…

1. Washington Stakeholders provide participating prescribers contact information

2. Patient encounter at a Washington hospital has an overdose diagnosis

3. EDie evaluates known PDMP prescribers and looks for those providers in the PDS

4. Matched prescribers are sent a fax/email notification for both fatal/non-fatal events

5. Notification will provide detailed information on the overdose event along with some recommendations about prescribing opiates

Presenter

Presentation Notes

When EDIE receives a code for overdose in the ED EDIE checks the PMP for recent prescribers and pulls contact information (email or fax) from EDIE’s provider directory. Recent prescribers are sent a fax or secure email detailing the overdose event in the approved format.

Strictly Confidential - ©2018 Collective Medical

Presenter

Presentation Notes

Notifications are sent for fatal and non-fatal overdose.

Washington State Department of Health | 14

Prescriber Feedback Reports

• Authorized by HB 1427 (2017)

• To show how prescriber’s acute opioid prescribing practices compare to those of their peers

• Self-assessment of opioid prescribing practices for quality improvement purposes

• Include useful recommendations and resources

• Sent to prescribers in the 95th percentile for at least one metric included in the report

Presenter

Presentation Notes

Authorized by ESHB1427, the PMP, in collaboration with HCA, LNI, WA State Hospital and Medical Associations, developed prescriber feedback reports To show how prescriber’s acute opioid prescribing practices compare to those of their peers To provide a means for self-assessment of opioid prescribing practices for quality improvement purposes, and To provide useful recommendations and resources Quarterly reports are sent to prescribers in the 95th percentile for at least one of the four metrics.


Process

• Significant stakeholder and partner input regarding content development and layout

• Production of crosswalk between NPI and Drug Enforcement Administration (DEA) numbers

• Production of specialty classification• Compliance with DOH Small Numbers Standards for privacy and

confidentiality• Linkages with licensing and registration lists for e-mail and mailing

addresses for dissemination

• Dissemination

Presenter

Presentation Notes

Considerable work goes in to create these reports. And because feedback is always welcome for improvements, refinements are ongoing. Significant stakeholder and partner input goes in regarding content development and layout for the metrics as well as the language in the report Several meetings scheduled around the state for public input took place from September 2017 to March 2018. Feedback is continuously being provided from stakeholders Production of crosswalk between National Provider Index (NPI) and Drug Enforcement Administration (DEA) numbers We developed a crosswalk in-house to accurately merge in taxonomy information from the NPI file Production of specialty classification We subset the NPI file to those providers who practice in WA and who are listed as entity type 1 (meaning, individuals), find the primary taxonomy code, keep the first 4 digits of the hierarchy, and created a format library of specialties, accounting for credentials. We then exclude non-individuals and those who are not authorized to prescribe controlled substances in WA, then create the metrics for all WA prescribers and their specialties. Compliance with DOH Small Numbers Standards for privacy and confidentiality After we compute the metrics, we ensure that certain filters are in place before ranking them to identify those in the 95th percentile. These include a min of 10 prescribers per specialty, and a min of 10 patients per prescriber Linkages with licensing and registration lists for e-mail and mailing addresses for dissemination Once all the prescribers are identified to receive a report, linkages are done to several references to locate an up to date contact information to send the reports. (PMP registration list, Secure Access WA account registration list, licensing from each Board and Commission, and NPI lookups, in this order) Dissemination: This is the step of physically mailing the correct report to the correct address and ensuring a secure email workflow for the electronically submitted reports.

Prescriber Feedback Report

Presenter

Presentation Notes

The first page of the report contains information that includes why they are receiving it, what its purpose is, the department’s authority to send it, what specialty they are being compared to based on their NPI, how many patients during that prescribing quarter the report is based on, the actual metrics defined, and how they can seek information on connecting their EHRs for seamless access. The second page contains recommendations for prescribing opioids based on AMDG and CDC guidelines, information about the PMP and the data they collect, information on the metrics, and a list of current resources, as well as our contact information.

+ Cover Letter

Presenter

Presentation Notes

We also include a cover letter that provides more clarification on the educational intent of the report, why they are receiving it, how the metrics and recommendations are based on guidelines and not the rules from their professions, a link to their profession’s rules for reference, and our contact information once again for any questions, concerns or feedback.


First Dissemination

• Based on 2018q1 prescribing

• Sent to 2,112 prescribers by• e-mail (1,656)• ground mail (456)

• Last week of October 2018

• Feedback • Failed delivery on 170/2,112 (8%)• Received via phone and e-mail from 65/(2,112-170) (3%)• …technical problem retrieving report; read-receipt; questioned

accuracy; assignment of specialty; help to understand metrics; how to verify; thank you; more info requested; what do I do now; want to receive one…

Presenter

Presentation Notes

The first dissemination was based on 2018q1 prescribing. Reports were sent to 2,112 prescribers, 78% via email and 22% via ground mail on the last week of October 2018. In total, 170 reports failed to be delivered (as undeliverable email or return to sender mailings). Feedback was received from about 3% of the prescribers who received a report. Comments ran the gamut – I tried to list a few – (…from people having technical difficulties retrieving the report, wondering if it required a read-receipt, questioning the accuracy of the results, saying that we got their specialty wrong but turns out they hadn’t updated their information on their NPI, some needing help to further understand the metrics, asking how to verify their prescriptions, we got thank yous, some wanted more metrics, more data, other wondered what they had to do now, and some even said my colleague got one, why don’t I have one, can I get one.)


Second Dissemination

• Based on 2018q2 prescribing

• Sent to 1,408 prescribers by• e-mail (911)• ground mail (497)

• First week of April 2019

• Added additional threshold of minimum 10 prescriptions for metrics 1 and 2; formatted language on report and cover letter for clarifications and to emphasize educational / QI intent

• Feedback • … assignment of specialty; questioned accuracy; want to receive one…

Presenter

Presentation Notes

The second dissemination was based on 2018q2 prescribing. Reports were sent to 1408 prescribers, 65% via email and 35% via ground mail, on the first week of April 2019. The lag is due to modifications and changes in some of the process we did as a result of feedback we received. We added an additional threshold of (iii) a minimum of 10 prescriptions for pediatric patients for one of the metrics, and (iv) a minimum of 10 prescriptions for adult patients for another one of the metrics. We also did some formatting of the language in the report and cover letter for clarifications and to emphasize the educational and quality improvement intent of the reports. Less feedback was received from the second dissemination, but numbers are not yet final. Most were concerned about misclassification of specialty. Unfortunately we have to rely on what they listed on their NPI. “I was hoping you could update my specialty to…” “I feel that my status as an OB/GYN does not adequately reflect the nature of the patients I care for…” “I wanted to find out why I have not received reports…”


Lessons Learned

• Expect and welcome feedback – iterative process of improvement• Communication is key

• Updated Frequently Asked Questions on our website• Provided clearer language as to the educational intent of reports • Emphasized that recommendations are based on prescribing

guidelines

• Dissemination is not trivial• Timeliness dependent on coordination of activities and receipt of

cascading communication

Presenter

Presentation Notes

Expect and welcome feedback. You will receive it and it will help you. This is an iterative process of improvement. Our methods are improving and our stakeholders are appreciative to contribute to that. Communication is key After the first dissemination, we updated the Frequently Asked Questions on our website We provided clearer language as to the educational intent of reports on several outlets (reports, cover letters, emails, presentations) And we emphasized that the recommendations are based on the prescribing guidelines and NOT on the rules, and that there is no punitive intent behind the reports. Dissemination is not trivial. It entails matching up the reports, addresses and cover letters, selecting which reports and letter should be sent via email and which via ground mail, generating the materials via mail merge, indexing the data as needed to prepare the two outputs, and building and testing a workflow to extract them for automated distribution using a secure process. We began working with the WA State Dept of Enterprise Services to help us with this process. Timeliness is dependent on coordination of activities and receipt of cascading communication. Coordination is needed from updating the NPI-DEA crosswalk, running the codes, and finding contact information, to printing PDFs and disseminating email and ground mail reports. All this while making sure entities listed in the resource section on the second page of the reports get a heads up that they are coming out, that Boards and Commissions have a heads up, that the hospital and medical associations have a heads up. And that our own PMP personnel get a heads up for incoming feedback.

Epidemiologists

PMP Contacts

Jian Gong

Mariana Rosenthal

Neal Traven

Fan Xiong

Contact InfoPhone: 360.236.4806 (option #2)

Email: [email protected]: http://www.doh.wa.gov/pmp

Program DirectorSasha De Leon

HelpdeskReem Aldaghestani

Eric Grace

Massa Mathis

Sara Staley

Operations ManagerGary Garrety

Secretary SeniorCece Zenker

Helpdesk ManagerMatthew Reid

Presenter

Presentation Notes

Please reach out to us if there are any questions, ideas for improvements, if you need any help with programming code, messaging, what have you. We are happy to help and to learn from you.


http://www.doh.wa.gov/pmp

Documents

Prescription Abuse Prevention Workgroup update