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Biomedical Informatics project for implementing a state wide screening program for narcotic seeking patients. Project defined from abstract to specific implementation and measurement criteria.
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Statewide Screening: Narcotics Seeking Patients at Urgent Care Facilities
CIS 512
Trevor Rohm
Winter 2009
Introduction limited resources
busy, and at times overburdened
With prescription drug abuse statistics estimating that as much as 10% of the population
Visiting multiple facilities is known as “doctor shopping”
limited narcotics monitoring program
Project Goals Verify
− Those who require narcotics are not seeking treatment from multiple providers
− Screening through the state narcotic monitoring program
− Freeing valuable limited resources
Design and implementation will focus on three key aspects: − People− Policy − Processes
Attention Areas Phase 1: Information gathering
about current numbers of patients to screen
Phase 2: Design and implementation of software interface with the state system
Phase 3: Workflow evaluation, modifications and implementation
Phase 4: Analysis and results
Limits− Primitive
experimental design to apply the intervention and then assess impact.
− No sampling− No pretest− No control group− A count of the
number of suspected narcotic abusers, will serve as our measurement
− 3 different cities− 5 five urgent care
facilities − Healthcare system− Adult only− Exclude children − Exclude pregnant
women
Pitfalls
− Not randomized − No control group− Single intervention group − Clinical providers rotate− Different patient
populations indigent patients rural community large migrant population urban downtown setting new affluent community
− They all serve unique populations, however, narcotic seeking patients have been known to frequent all 5 facilities, sometimes all in a single day.
Phase 1: Information Gathering Determine
− the total number of patient visits − total number of unique patients − the corresponding chief complaints for each visit
Count − number of patient visits− number of unique patients− number of visits per patient
Correlational study− number of times a patient presents to the Urgent Care − number of prescriptions (Rx) for narcotics given
Data plotted in 2 graphs. One for # of Rx and the other for # of pills.
Project implementation and resource allocation
Phase 2: Design and Evaluation
Current Narcotic Monitoring System− Requires pharmacies to upload
information for all narcotics prescriptions − Once a month− Batches may be uploaded online, sent by
magnetic tapes, CDs or by paper processes
− Single aggregate database
Project design will include a user-friendly, provider view of the state database
develop a real-time web-based system interface for Urgent Care facilities
Phase 3: Workflow Changes Necessary to involve the whole healthcare team:
− registration clerks− triage nurses− healthcare providers
Backup procedures system failure or internet outage
Policy so each team member can fulfill their job to capacity
Implementation must NOT limit healthcare providers nor interfere with their ability to care for patients
Information provided by the state can be used to help the provide care, however, it should never preclude prescribing additional medication if clinically indicated
Policy should never impede patient care and should always promote patient safety
Administration fully support project
Phase 4: Analysis and Results 12 months of data
Count of the number of Rxs for narcotics and the number of pills will be determined.
A correlational graph will be plotted
We will compute the following:− percentage of total visits by reported patients− the total number of narcotic Rxs provided these patients− the total number of pills provided these patients− the average number of pills per patient− the average number of Rxs per patient− the average number of visits per patient− average cost per visit (as determined by administrative data)− total cost for all potential drug seeking patients visits
Success by measuring the number of patients that have “pain” who are found to have received multiple narcotic prescriptions from various providers
Data analysis can show how these costly resources can be
Conclusion Prescription narcotic drug abuse is common and Urgent
Care facilities are often frequented by these patients
By allowing the provider access to information kept by the state, drug seeking patients can be “weeded out” , thereby freeing resources and easing the burden on providers, at urgent care facilities throughout the state of New Mexico
Patient quality of care can be increased by allowing providers more time with patients in need and allow providers the ability to know what narcotic medications the patient is taking
Providing a means of screening for potential narcotic seeking patients can be another tool to aid providers in patient care, and save limited resources
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