Prescription Drug Monitoring Program Use and Utility by Washington State Pharmacists: A Mixed Methods Study

Abstract

Objectives: To explore factors and situations that influence pharmacists to utilize the prescription drug monitoring program (PDMP) and to characterize actions taken by pharmacists following alarming scenarios from a PDMP query. Also, to explore the theory of planned behavior’s (TPB) utility, along with perceived obligation, in predicting pharmacists’ high intention to utilize the PDMP. Design: Explanatory sequential two-phase mixed methods design: (1) cross-sectional web-based survey of Washington State pharmacists followed by (2) interviews with purposefully selected respondents to explore significant quantitative findings. Setting: Washington State from September 2018 to February 2019. Participants: A total of 967 Washington State pharmacists from various practice settings, including inpatient and outpatient pharmacies. Ten outpatient pharmacists were interviewed in the second phase. Outcome measures: Pharmacist reported the frequency of PDMP use, opinion on the usefulness of PDMP, action(s) taken following a concerning PDMP report and a model to predict pharmacists’ high intention to utilize the PDMP by applying the TPB with the addition of perceived obligation. Results: The usable response rate for pharmacists with a PDMP account was 17.6% (818/4659) and for all pharmacists was 10.4% (967/9263). PDMP use varied by ethnicity, practice setting and employer policy on PDMP use. Among the 818 PDMP users, 396 (48%) utilized the database at least once during a shift. Frequent PDMP users were more likely to recommend naloxone compared to less frequent users (Adjusted odds ratio, 1.70; 95% confidence interval, 1.09-2.65; P = 0.02). The constructs of subjective norms, perceived behavioral control, and perceived obligation significantly predicted pharmacists’ high intention to utilize the PDMP (P = <0.001). Conclusion: PDMP has value to pharmacists of all practice settings studied. Frequent PDMP use may facilitate more pharmacist-interventions, such as a naloxone prescription. Outreach, training and communications that address pharmacists’ subjective norms, perceived behavioral control and perceived obligation may be more likely to increase pharmacists’ high intention to utilize PDMP.