Thursday, May 05, 2016

Does A Move To Real Time Narcotic Prescription Monitoring Say Something About The Value Of The myHR in Medication Management?

This release appeared last week:

Real Time Prescription Monitoring Will Save Lives

25 April 2016
The Andrews Labor Government is taking action to reduce the number of Victorians dying from prescription drug overdoses, with the introduction of a real-time prescription monitoring system.
With more people losing their lives each year in Victoria from overdoses of prescription drugs than those dying in road accidents, a real-time prescription monitoring system has the potential to prevent the deaths of up to 90 Victorians over the next five years.
Many prescription overdoses result from people “prescription shopping” from multiple doctors and pharmacies. Without a centralised monitoring system, this often goes undetected with tragic results.
A real-time monitoring system will help our medical clinics, pharmacies and hospitals better identify prescription drug seekers earlier, before their addiction escalates into serious harm.
Since 2012, there have been 21 coronial findings calling for the implementation of a Victorian real-time prescription monitoring system, however the former Liberal Government failed to act.
To implement this life-saving initiative, we will provide close to $30 million in the 2016-17 Victorian Budget to roll out the monitoring software, provide additional counselling and addiction treatment services, as well as providing training and support for doctors and pharmacists to identify and help prescription drug misusers early.
Once implemented, the system will allow clinicians at 1900 GP clinics, 1300 pharmacies and 200 hospitals to do an on-the-spot check before prescribing or dispensing medicines that are at high risk of misuse.
This is expected to reduce the number of people taken to emergency departments with overdoses by more than 500 per year, and see a further 700 people a year referred to counselling to try and beat their addiction.
The scheme will include Schedule 8 medicines such as morphine and oxycodone at a minimum, and the Government will consult with professional medical and pharmacy groups to determine the best way to include other high-risk medicines such as diazepam.
In 2015, 330 Victorians lost their lives due to prescription drug overdoses – 5 per cent more than the previous year. This is higher than the 217 overdose deaths from illicit drugs and the 252 people killed in road accidents.
Quotes attributable to Minister for Health Jill Hennessy
“With more Victorians dying every year from prescription drug overdoses than road accidents, we can’t afford to wait any longer to take action.”
“We have listened to the families who have experienced first-hand the tragedies of prescription medicine overdoses, and we’re getting on with delivering this life-saving initiative.”
Quotes attributable to Minister for Mental Health Martin Foley
This will help us identify people misusing prescription drugs earlier, so they can get the support and treatment they need to beat their addiction.”
The release is found here:
Typical of the press commentary was this:

Doctors welcome Vic prescription drugs plan

26 April 2016
The Victorian government has committed $30 million to a real-time prescription monitoring system in an attempt to crack down on doctor and prescription shopping.
The centralised system will allow doctors and pharmacists to do on-the-spot checks before prescribing or dispensing medicines that have a high risk of misuse, such as morphine and oxycodone.
Health Minister Jill Hennessy says it is a “life-saving initiative” that will help identify drug seekers before their addiction escalates.
AMA Victoria president Dr Tony Bartone says the development has been a long time coming.
“The thing that stands out most is that more people die from prescription medicine overdoses than in road accidents in Victoria,” says Dr Bartone, who is a practising GP.
“In most practices there is a blanket ban on these kinds of drugs. However, this prevents access for people who really need them. At the same time, there’s nothing worse than to find out that one of your patients has been seeing other practitioners for prescriptions,” says Dr Bartone.
Part of the funding will go towards counselling and addiction treatment services, as well as training and support for doctors and pharmacists to help identify drug misusers early.
Pharmacy Guild of Australia Victorian branch president Anthony Tassone says the government is showing “great vision”.
While a new monitoring system will go a long way towards identifying patients with a drug misuse concern, addiction and counselling services are also vital, he says.
“This is a complex issue that needs a broad solution, and the Victorian government has shown great vision in recognising that a software system alone is not the complete answer.”
According to the government, 330 Victorians died from prescription overdoses in 2015. That’s 100 more than those who died from illicit drugs in the same year.
Since 2012, there have been 21 coronial findings calling for the implementation of a Victorian real-time prescription monitoring system.
More here:
What struck me with this was that to have it work there would need to be both a database of all narcotic and benzodiazepine prescriptions, some form of pretty robust patient identification and access to the database available for all dispensers and prescribers.
There also seem to be a range of privacy, consent and confidentiality issues which I imagine need to be addressed legislatively.
That said - how does all this differ from providing access to the myHR using the medication records collected via eTP and the PES services.
It is by no means clear to me how these apparently parallel systems interact or overlap and why we need both? I look forward to having this all explained to me and the readers.
David.

5 comments:

Bernard Robertson-Dunn said...

One difference is that in the MyHR, patients can a) opt-out or b) restrict the data that cam be put into their record. Makes it useless for prescription monitoring.

This means that it would be very difficult to stop patients who are determined to get more than they really should from hiding their tracks.

Yet another reason not to let patients control their health records. By all means encourage a patient's GP to provide them with a meaningful summary of their health status, but that could be done by printing it out, or if necessary, putting it on a thumb drive (as has been discussed here)

You can buy a lot of paper and thumb drives for $2billion.

Anonymous said...

The MyHR is useless for prescription monitoring. I don't think any Health Department has suggested that it could be used to address doctor shopping; have they?

Anonymous said...

The Victorian Health Minister said "The scheme will include Schedule 8 medicines such as morphine and oxycodone at a minimum, and the Government will consult with professional medical and pharmacy groups to determine the best way to include other high-risk medicines such as diazepam."

Most doctor shoppers operate outside of the Schedule 8 medicines so a system that is limited to Schedule 8 will be of very little use.

Anonymous said...

ABCs Writs and Cures: Bill and Steve's Radio Adventures on 26 April http://www.abc.net.au/melbourne/programs/podcasts.htm?ref=nav covered the issue well but I couldn't understand why they needed to employ 30 pharmacists to support the system!





Anonymous said...

Law Institute president plus preventing prescription drug overdoses - ABC Melbourne - Australian Broadcasting Corporation - ABC Melbourne (29 Apr 2016)
Special guest on Writs and Cures is the President of the Law Institute of Victoria, Steven Sapountsis. The team also look at the Real Time Prescription Monitoring Service.