title: How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?
abstract: OBJECTIVE
  The prescription opioid epidemic is currently responsible for the greatest number of unintentional deaths in the United States. One potential strategy for decreasing this epidemic is implementation of state-based Prescription Drug Monitoring Programs (PDMPs), which are designed for providers to identify patients who "doctor shop" for prescriptions. Emergency medicine physicians are some of the most frequent PDMP users and opioid prescribers, but little is known about how they actually use PDMPs, for which patients, and for what reasons.
  
  
  METHODS
  We conducted and transcribed semistructured qualitative interviews with 61 physicians at a national academic conference in October 2012. Deidentified transcripts were entered into QSR NVivo 10.0, coded, and analyzed for themes using modified grounded theory.
  
  
  RESULTS
  There is variation in pattern and frequency of PDMP access by emergency physicians. Providers rely on both structural characteristics of the PDMP, such as usability, and also their own clinical gestalt impression when deciding to use PDMPs for a given patient encounter. Providers use the information in PDMPs to alter clinical decisions and guide opioid prescribing patterns. Physicians describe alternative uses for the databases, such as improving their ability to facilitate discussions on addiction and provide patient education.
  
  
  CONCLUSIONS
  PDMPs are used for multiple purposes, including identifying opioid misuse and enhancing provider-patient communication. Given variation in practice, standards may help direct indication and manner of physician use. Steps to minimize administrative barriers to PDMP access are warranted. Finally, alternative PDMP uses should be further studied to determine their appropriateness and potentially expand their role in clinical practice.
authors: Department of Emergency Medicine, Center for Emergency Care Policy & Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Robert J
authors: http://orcid.org/0000-0001-9746-1230
authors: RJ
authors: Smith
authors: Department of Emergency Medicine, Center for Emergency Care Policy & Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.|Department of Emergency Medicine, Highland Hospital, Oakland, California.
authors: Austin S
authors: AS
authors: Kilaru
authors: Department of Emergency Medicine, Center for Emergency Care Policy & Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.|Division of Medical Toxicology, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Jeanmarie
authors: J
authors: Perrone
authors: Department of Emergency Medicine, Center for Emergency Care Policy & Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Breah
authors: B
authors: Paciotti
authors: Mixed Methods Research Lab, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Frances K
authors: FK
authors: Barg
authors: Mixed Methods Research Lab, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Sarah M
authors: SM
authors: Gadsden
authors: Department of Emergency Medicine, Center for Emergency Care Policy & Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Zachary F
authors: ZF
authors: Meisel
mesh_terms: D000328:Adult; D003226:Congresses as Topic / Q000592:standards; D016903:Drug Monitoring / Q000379:methods / Q000592:standards; D004635:Emergency Medicine / Q000592:standards*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D063487:Prescription Drug Misuse; D055553:Prescription Drugs / Q000627:therapeutic use; D015813:Substance Abuse Detection / Q000379:methods / Q000592:standards*; D011795:Surveys and Questionnaires
chemical_list: D055553:Prescription Drugs
keywords: Emergency Care; Healthcare Providers; Prescription Monitoring Programs; Prescription Opioids