Simple reminder emails increase clinicians' use of the database for safe opioid prescribing.

Simple reminder emails increase clinicians' use of the database for safe opioid prescribing.

New study on the use of databases for safe medication prescribing

A new randomized clinical trial shows that simple reminder emails significantly increase physicians' use of a database that supports safe prescribing of opioids and other medications. However, opioid prescribing patterns themselves did not change significantly during the study period. The study was led by researchers at Columbia University Mailman School of Public Health and the University of Southern California and the results were published inJAMA Health Forumpublished.

What are Prescription Drug Monitoring Programs (PDMPs)?

PDMPs are databases that track the prescribing of opioids and other highly regulated medications. All states in the U.S. operate such programs, and most require doctors to create accounts and review the system before prescribing opioids. Despite these requirements, compliance is inconsistent, which is an ongoing policy concern.

"Our study shows that emails can encourage doctors to create accounts and use their state prescription drug monitoring program. We find these results exciting because these databases can help prescribe more safely, but many physicians still don't use them."

Adam Sacarny, PhD, associate professor of health policy and management at the Columbia Mailman School of Public Health and principal investigator of the study

Methodology of the study

In the new study, researchers worked with the Minnesota state government to gather evidence on cost-effective interventions to improve prescribing safety. The study focused on 7,872 physicians and physician assistants who did not meet state requirements to maintain a PDMP account or search the system before prescribing. Physicians were randomly divided into three groups: emails that emphasized the state's legal requirements for use of the PDMP, emails that focused on clinical guidelines and use of the PDMP, and a control group that received no emails. The researchers then tracked PDMP usage and prescribing behavior.

Results of the study

Both types of emails significantly increased engagement with the PDMP, including account creation, searching, and querying patients with a history of risky prescribing. Emails that emphasized legal requirements resulted in a more than threefold increase in engagement. Emails highlighting clinical benefits were also effective, but less pronounced: they resulted in more than twice the engagement. Thankfully, it was determined that none of the emails had any impact on the prescription.

“The legal requirements emails were particularly encouraging because they resulted in one in four physicians using the PDMP who otherwise would not have,” said Mireille Jacobson, PhD, the study's final author and a professor of gerontology and public policy at the University of Southern California. “Although the emails have not changed opioid prescribing, simply encouraging the creation of PDMP accounts and use of the PDMP could still lead to safer and more informed patient interactions.”

Data came from the Minnesota PDMP and included all prescription drugs dispensed in the state. Prescribing behavior and use of the PDMP were tracked seven months after the first email. The effects of PDMP use were long-lasting, lasting at least seven months after the first email.

Further insights

The results build on previous work by Sacarny and colleagues showing that simple messages can effectively promote use of the PDMP. In a previous study that sent letters to doctors instead of emails, messages indicating legal obligations outperformed clinically worded messages, with neither method influencing prescribing.

“Email is a cost-effective and scalable intervention that significantly increases engagement with the PDMP, especially when legal requirements are emphasized,” said Sacarny. “These interventions could also serve as templates for efforts to promote other health care best practices.”

“Our approach is based on randomized trial evidence and can be easily transferred to other contexts,” added Sacarny. “The results should be useful and encouraging to policymakers, health systems and organizations focused on safe prescribing and patient safety.”

In addition to Sacarny and Jacobson, co-authors are Tatyana Avilova, Secretariat; and Ian Williamson and Weston Merrick of the Minnesota Management and Budget Agency.

The study was supported by the Abdul Latif Jameel Poverty Action Lab.

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