SafeUseNow: A Prescriber Intervention Program

San Diego—According to statistics from the Centers for Disease Control and Prevention (CDC), nonmedical use of prescription drugs is the second leading cause of accidental death in the United States. In addition, an analysis conducted in February 2013 by investigators at the CDC found that 75.2% of pharmaceutical deaths involved opioids, either alone or in combination with other drugs. Other data from the National Center for Health Statistics show that deaths from drug overdose increased in 2010 for the 11th consecutive year, an increase driven largely by opioid analgesics.

At a Pharmacy Partnership Briefing session at the AMCP meeting titled SafeUseNow^SM: A Controlled Substance Risk Identification and Prescriber Intervention Program, speakers provided attendees with an overview of the program. The speakers were Saira A. Jan, MS, PharmD, director of clinical pharmacy management, Horizon Blue Cross Blue Shield of New Jersey, and clinical professor, Rutgers, The State University of New Jersey, Lawrence Feinstein, PhD, vice president, clinical program development, Principled Strategies, Inc., and Stephen D. Cuttis, PharmD, AE-C, CDOE, director, clinical programs, CDMI, LLC.

The session began with a discussion of the impact of prescription drug abuse on the cost of care. Among nonabusers, the average annual per patient healthcare costs are $1830 to $2210, compared with $15,884 to $18,338 among abusers. Hospital admissions for opioid abuse saw a 456% increase from 1997 to 2007 and emergency department (ED) services in oxycodone-related visits increased 7 fold from 1996 to 2002. Compared with nonabusers, opioid abusers are 4 times more likely to visit the ED, have 12 times as many hospital admissions, and 63 times as many outpatient visits, according to data presented at the session.

Efforts to deal with the issue of abuse of prescription drugs by commercial and Medicare plans include the use ofusing patient-specific prescription data to identify patients with aberrant medication behavior, and providing constraints on patient-access to medications, such as case management review and point-of-service unit limits, and access to state prescription monitoring programs.

The SafeUseNow program was designed with a prescriber-centric approach to augment patient-focused efforts already in place. Program objectives include identification of prescriber factors of inappropriate prescribing (intentional and unintentional), coordination of care with behavioral health case managers, safe use of powerful opioid medications for patients being treated for pain, and accurate diagnosis and referral to treatment for addiction or diversion for patients with abuse issues.

SafeUseNow has developed a PSI^™ Score, an algorithm based on an advanced analytic model that evaluates prescriber and patient behavior contributing to the risk of misuse, abuse, and addiction. The score is a prescriber-specific aggregate of 17 risk factors observed in the prescriber’s patients’ prescription data. Each prescriber’s risk is determined relative to all other prescribers and specialty peers. The PSI Score is then used to predict risky prescribers by identifying those prescribers who are trending upward.

In initial results of the PSI Score utilization, 1200 prescribers were identified for engagement at or above the 98th percentile of the PSI Score distribution. The top risk factors (those occurring most frequently among prescribers’ top 3 risk factors) were early refills of similar products, dosage and volume of opioids, opioids with benzodiazepine or carisoprodol concomitance, and excessive use of controlled substances.

When a prescriber has a high PSI Score, “it is likely that there are actions that the prescriber is not doing to reduce risk and improve patient safety. The higher the risk level, the greater the opportunity to improve patient safety,” the speakers said.

SafeUseNow interventions for at-risk prescribers included engagement, consultation, and follow-up. The engagement phase included a packet mailed to at-risk prescribers with clinical advisories specific to each prescriber’s risk factors. The consultations included a 20-minute telephone call or office visit with a pharmacist trained in the program protocol, as well as printed materials that included suggestions for patient referrals to behavior health care. Follow-up was done 6 months after the consultation appointment and the prescribers were given 3- and 6-month updates on their PSI Scores.

The session concluded with the results of the initial phase of the program. All prescribers who were contacted acknowledged a need to address controlled substances, noting that the inclusion of detailed prescription information for the prescriber’s own patients was a major contributor to prescribers’ willingness to participate. The majority of prescribers preferred an appointment by telephone.

While most of the prescribers expressed concern about being “monitored” by the payer, they were highly motivated to discuss the program. When the program pharmacist reviewed the themes and goals of SafeUseNow, the prescribers’ comfort and collaboration increased.