Reminder Letters Encourage Doctors To Use Prescription Monitoring Program

PMP databases could encourage safer prescribing—if doctors use them

The study, published this month in the journal Health Affairs, enrolled 12,000 clinicians in Minnesota who prescribed opioids to patients also on benzodiazepines or gabapentinoids.^[1] As both opioids and the other two classes of drugs can cause sedation and respiratory depression, the combination increases the risk of overdose.

The researchers hypothesized that greater use of state prescription monitoring programs (PMPs) would help doctors avoid giving patients risky combinations of drugs. Nearly all states in the US now have PMPs, displaying to doctors the history of controlled substance dispensing to individual patients. However, many doctors don’t use the databases.

“PMPs could help clinicians prescribe opioids and other drugs more safely, but these databases will only move the needle if clinicians actually check them,” said Adam Sacarny, lead author of the study and assistant professor of health policy and management at Columbia University’s Mailman School of Public Health.^[2]

Letters reminded doctors of the state mandate to check the PMP

To conduct the trial, researchers partnered with the Minnesota Board of Pharmacy, which runs the state’s PMP, and the Minnesota Management and Budget Agency, which promotes the use of high-quality evidence to guide state decision-making.

They randomly assigned the 12,000 doctors to a control group or to receive one of three letters. Mandate letters reminded doctors of a new state mandate to check the PMP before prescribing opioids and encouraged them to make accounts to do so. Information letters provided information about the risk of co-prescribing and a list of their patients who had been prescribed both opioids and benzodiazepines or gabapentinoids. A combination letter included both messages. The letters were sent in the spring of 2021.

Some letters increased PMP searches

In the following months, the researchers then analyzed the effects of the letters, looking at anonymized data from the PMP, including all opioids, benzodiazepine, and gabapentinoid (gabapentin) prescriptions dispensed throughout the state and PMP account records and searches.

The two letters that mentioned the state mandate to check the PMP increased clinician engagement with the database. PMP search rates rose by 9% among the doctors who received those letters, a change that lasted at least eight months.

“The enduring impacts suggest that the letters encouraged engagement among clinicians who would not have otherwise created PMP accounts or searched the PMP. This finding is noteworthy because account creation is an important barrier to PMP use,” said study author Mireille Jacobson, associate professor of gerontology at the University of Southern California.

No significant effect on prescribing

The information letters had no detected effects. And none of the letters led to a significant change in prescribing. But the researchers insisted the letters were still worthwhile.

“While the letters did not make a detectable difference in prescribing, we still think these results are encouraging,” Sacarny acknowledged. “Letters focusing on the mandate successfully promoted PMP engagement through searching and account-holding, which meant clinicians had better access to key patient data as they decided on treatment.”

They said healthcare organizations in other states could send similar letters as part of a cost-effective, evidence-based strategy to encourage safer prescribing. The letters, which don’t contain protected health information, could also be sent over email, further reducing costs.