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Transcript of 2017 Pharmacy Update Tennessee Controlled Substance ... · Adds a professional duty to check the...
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 1
Tennessee Controlled Substances Monitoring Database Program as a Tool to Improve Patient Care and Fight the Drug Epidemic
D.ToddBess,Pharm.D.DirectorTennesseeControlledSubstanceMonitoringDatabase
April 12, 2018
• I have no financial relationships to disclose.
• I will not discuss off label use and/or investigational use in my presentation.
DisclosureInformation
• Appriss will probably move the CSMD to a new platform in the near future.
• In order for you to move with it, you MUST have and keep active email address in CSMD that is unique and only you have access.
• If you are required by law to have access to CSMD and do not keep an active email in “My Account” of current platform, you will have an issue with access to the CSMD once the transition occurs.
• Please remember to revoke any Supervisory Relationships that are no longer active.
CSMDNewsFlash!
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 2
NewFeatureonPatientReport
• Language on patient report to remind users on how this patient was identified and has a padlock icon associated with a name on the report. ▫ The patient with the lock indicator before the name has the same first
name, last name and date of birth of a person that has been reported to the CSMD by TennCare, and has been locked into a single pharmacy (TennCare will only provide coverage for this patient at their assigned pharmacy). Please assess if your patient is an active TennCare Enrollee that is locked into one pharmacy, and if so please refer this patient's pharmacy care to their assigned pharmacy.
ComingSoon:NewFeatureonPatientReport
2017MembersoftheCSMDCommittee
Member Name Board
Melanie Blake, M.D. Board of Medical Examiners
Katherine N Halls, DDS Board of Dentistry
Brent Earwood, APN, CRNA Board of Nursing
Brad Lindsay Board of Optometry
Shant Garabedian, DO Board of Osteopathy
Mike Dickerson, D.Ph. Board of Pharmacy
Sheila Schuler, DPM Board of Podiatry
Stephen Ladd, DVM Board of Veterinary Medical Examiners
Omar Nava, PA‐C Committee on Physician Assistants
Robert Ellis Public Member Board of Medical Examiners
Lisa Tittle Public Member Board or Pharmacy
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 3
DoallHealthcareProvidershavetoRegister?
“If you provide direct care and prescribe controlled substances to patients in Tennessee for more than 15 days per year or you are a dispenser in practice providing direct care to patients in Tennessee for more than 15 days per year, you are required to
register with the CSMD.”
• CSMD FAQ on website has been updated
• https://www.tn.gov/health/health‐program‐areas/health‐professional‐boards/csmd‐board/csmd‐board/faq.html
• Requirements for Prescribers and dispensers are now similar
▫ Adds a professional duty to check the database before prescribing to someone exhibiting drug seeking behavior for any controlled substance
▫ Adds requirement for dispensers to check patients with prescriptions for opioids and benzodiazepines similar to prescribers
• Add CRNAs as providers that can have access
• Effective upon the Governor’s signature on April 27, 2016
PrescriptionSafetyAct2016(PublicChapter1002)
WhyisitimportanttochecktheControlledSubstanceMonitoringDatabase?
Despite the rise in opioid abuse, during the fall of 2015, a single patient was able to procure 89 prescriptions in a 90 day period by visiting a large number of dentists throughout the state of Tennessee.
*Additional information* No single prescription would
have hit the mandatory check requirement
Patient used multiple pharmacies
Prescribing history may show specific trends in prescriptions filled
Prevention of potential overdose
Pharmacist intervention as another mode of
defense
Doctor Shopping could have
been avoided
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 4
• Patient Report
• Prescriber Analytics for the CSMD
• Reports and Survey
OutlineforDataAnalyticsRelatedtoTNControlledSubstanceMonitoringDatabase(CSMD)
CSMD Data Analytics
PATIENTREPORT
ConsiderationswithuseoftheTennesseeCSMD
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 5
PatientRequestPage:OptionalQuestionAddedforUserstoIndicateSuspectedOverdoseorPoisoning
Training User
“None” of these Patients
ClinicalRiskIndicators(highriskpatients)onCSMDReports
Y = 4 Practitioners in last 90 days
Y= 4 Pharmacies in last 90 days
Y ≥ 90 but < 120 Active Cumulative Morphine Equivalents per day
R≥ 5 Practitioners in last 90 days
R ≥ 5 Pharmacies in last 90 days
R≥ 120 Active Cumulative Morphine Equivalents per day
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 6
ClinicalRiskIndicators(highriskpatients)onCSMDReports
Female and child bearing age (15‐45 years of age)
“Please remember that narcotic prescriptions for women of child bearing age could result in Neonatal Abstinence Syndrome (NAS) should pregnancy occur; please discuss with your patient methods to prevent unintended pregnancy.”
PaymentType IdentifyingNumber
PrivatePay 01
Medicaid 02
Medicare 03
CommercialIns. 04
MilitaryInst.andVA 05
WorkersComp 06
IndianNations 07
Other 99
ConsiderationsWhenReadingCSMDReport
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 7
PROPOSEDGatewayStatePMPClinicalRiskIndicators
PROPRIETARY AND CONFIDENTIAL
This example provided to TN CSMD by Appriss for educational purposes.
Remove a Linked Patient from a Gateway Report
You have the ability to remove linked patients
in the Patient Information section.
Linked Records are any patient records that were linked to make up this Patient Report. To the far right is an interactive column labeled Mark X to Remove.
Each record in this list can be clicked and selected for removal from this Patient’s report.
(The ability to remove records within PMP
Gateway will be available in Q3/Q4 of 2017.)
Sample Gateway Report integrated into an EMR System
PROPRIETARY AND CONFIDENTIAL
This example provided to TN CSMD by Appriss for educational purposes.
RemoveLinkedPatientswithinGatewayReport
Remove a Linked Patient from a Gateway Report(continued)
To remove one or more linked record from a
patient report:
1. Mark the patient(s) to be removed from the patient report by clicking Remove. A red “X” will appear marking the record for removal. To unmark it, click remove again. When you mark the first patient for removal, two action buttons will automatically appear. TIP: Mark all patients you want removed from the report before you click Remove X Marked.
2. Click the Remove X Marked button to process the marked record(s) and re-run the report.
Sample Gateway Report integrated into an EMR System
PROPRIETARY AND CONFIDENTIAL
This example provided to TN CSMD by Appriss for educational purposes.
RemoveLinkedPatientswithinGatewayReport
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 8
View Refreshed Gateway Patient Report
The refreshed report will automatically display
excluding the patients that were removed,
including all associated prescription history
information.
• Sample Gateway Report integrated into an EMR System
PROPRIETARY AND CONFIDENTIAL
This example provided to TN CSMD by Appriss for educational purposes.
RemoveLinkedPatientswithinGatewayReport
CSMD Data Analytics
PRESCRIBERRELATEDACCESSTOREPORTS
PractitionerSelfLookup
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 9
PractitionerSelfLookupwithOptiontoIncludeAPRN/PA
PrescriberDashboardinCSMD(CSMDproductiondate8/6/2017)
• Available in the past
• Turned off due to alert fatigue
• Recently reengineered to avoid alert fatigue
• Order of Notifications▫ Correlates to indicators on patient reports with slight variation as no symbols on dashboard
but if you click view all notifications the symbols will appear
– Multiple Practitioners ≥ 5
– Multiple Dispensers ≥ 5
– Multiple Practitioners = 4
– Multiple Dispensers = 4
– MME ≥ 120
– MME ≥ 90 <120
CSMDUserDashboard(ClinicalRiskNotifications)a
PrescribersreceiveemailsfromCSMDeachweekiftheyhavenewnotifications
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 10
Welcomes Test Test
CSMDUserDashboard(ClinicalRiskNotifications)
• 60% of respondents received a Clinical Risk Notification
▫ 71% felt the information was useful
• How did the information increase awareness (could choose more than one response)
▫ 89% more aware of patients going to multiple prescriber
▫ 57% more aware of patients going to multiple dispensers
▫ 66% more aware of patients receiving highest dose of opioids
ClinicalRiskNotificationsonHomePageinCSMD
Practitionervs.PeerReport
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 11
ProposedCSMDPrescriberReport
Multiple provider and dispenser thresholds exceeded
Requests for You / Your Delegates
CSMD Data Analytics
REPORTSANDSURVEYS
• In 2016, approximately 94% of overall Controlled Substances Prescriptions in TN were dispensed by licensed pharmacies and reported to the TN CSMD.
• Special thanks to pharmacy practice, human prescriber dispensers, and veterinarian prescriber dispensers across Tennessee for helping build a powerful tool that allows Tennessee to better fight the Prescription Drug Crisis!
PrescriptionsintheTNCSMD
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 12
*VA registrants were included in 2013 ‐ 2017.
NumberofRegistrantsoftheCSMD,2010‐2017*
13,18215,323
22,192
34,802
38,87142,835
46,576
47,294
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
2010 2011 2012 2013 2014 2015 2016 2017
Nu
mbe
r of
Reg
istr
ants
Year
RatioofNumberofPrescriptionstoNumberofRequestintheCSMD,2010‐2017*
Prescribers
Strongly Agree Somewhat Agree Neutral/No Opinion
Somewhat Disagree Strongly Disagree
30%
35%
25%
4% 6%
Prescribers
51%
28%
19%
1% 1%
Dispensers
AfterviewinginformationfoundintheCSMD,Ichangedthetreatmentplanforapatient
AfterviewinginformationfoundintheCSMD,Irefusedtofillaprescriptionaswritten
Source: 2017 CSMD Prescriber and Dispenser Survey
~ 65% of Prescribers have changed their treatment plan
~ 79% of Dispensers are less likely to fill a prescription as written
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 13
NumberofPrescriptionsReportedtoTNCSMD,2010‐2017*
NumberofPrescriptionsReportedtotheTNCSMDbyClassofControlledSubstances,2010‐2017*
NumberofStimulantPrescriptionsDispensedAmongTNPatientsandReportedtotheCSMD,2010‐2017*
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 14
NumberofBenzodiazepinePrescriptionsDispensedAmongTNPatientsbyAgeGroupandReportedtotheCSMD,2010‐
2017*
MMEforLongActingOpioidsReportedtotheCSMD,2010‐2017*
MME for Long Acting Opioids Reported to the CSMD, 2010‐2017*
Year Overall patients in CSMD
TN patients Change among TN patients (%)
2010 3,186,575,097 3,053,655,395 ‐
2011 3,250,846,435 3,117,382,279 2.1
2012 3,281,165,787 3,144,485,150 0.9
2013 3,234,719,734 3,102,687,379 ‐1.3
2014 2,921,833,043 2,803,168,526 ‐9.7
2015 2,549,901,625 2,451,782,440 ‐12.5
2016 2,122,567,448 2,043,554,990 ‐16.7
2017 1,626,479,677 1,565,314,892 ‐23.4
* 1) The classes of controlled substances were defined based on a CDC document; 2) Excluding prescriptions reported from VA pharmacies; 3) Excluding buprenorphine products.
MMEforShortActingOpioidsReportedtotheCSMD,2010‐2017*
MME for Short Acting Opioids Reported to the CSMD, 2010‐2017*
Year Overall patients in CSMD
TN Patients Change among TN Patients (%)
2010 5,037,050,762 4,862,233,311 ‐
2011 5,725,823,620 5,467,276,130 12.4
2012 5,888,549,934 5,642,626,206 3.2
2013 5,673,351,755 5,456,618,080 ‐3.3
2014 5,493,079,304 5,281,031,358 ‐3.2
2015 5,368,706,323 5,165,968,521 ‐2.2
2016 5,043,745,375 4,860,744,219 ‐5.9
2017 4,582,128,792 4,425,089,600 ‐9.0
* 1) The classes of controlled substances were defined based on a CDC document; 2) Excluding prescriptions reported from VA pharmacies; 3) Excluding buprenorphine products.
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 15
ChangeinMMEDispensedAmongTNPatients,2011‐2017*
76%
5/5/90
Thenumberofpotentialdoctor/pharmacyshoppersdeclined76%between2011and2017
2017 Pharmacy UpdateFebruary – April, 2017
Tennessee Controlled Substance Monitoring Database
D. Todd Bess, PharmD 16
Conclusion
• Tennessee Controlled Substances Monitoring Database (CSMD) is a powerful tool to help protect your patients and your community
• Clinicians value and respond to their assessment of TN CSMD Patient Reports
• Major improvements of the CSMD Program are coming soon!
• Pharmacist and Pharmacies in your area can increase access to Life Saving Naloxone so discuss the new Collaborative Practice Agreement with THD Chief Medical Officer with your team to serve your patients and community!