Medication-related adverse events are affecting record numbers of Medicare beneficiaries in the United States. According to the Centers for Disease Control and Prevention (CDC), opioids — including prescription drugs and heroin — killed more than 33,000 people in the U.S. in 2015. Among Medicare beneficiaries, six out of every 1,000 beneficiaries has an opioid misuse disorder — one of the fastest growing rates in the nation.
The New England Quality Innovation Network – Quality Improvement Organization (QIN-QIO)—serving Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont — is addressing this issue by implementing strategies to help better manage patients’ use of opioids across the care continuum.
In September 2016, the New England QIN-QIO partnered with the Connecticut Department of Consumer Protection in an initiative that will better utilize data from its prescription drug-monitoring program (PDMP) for quality improvement. Using data points that pharmacies report into the PDMP, the QIN-QIO will look at trends over time and identify areas of opportunity to promote medication reconciliation at the community level.
Six out of every 1,000 beneficiaries has an opioid misuse disorder.
“We recognized that the data being collected could be used for much more than just tracking patients who were abusing opioids,” said Marghie Giuliano, a pharmacist with the New England QIN-QIO. “The data could have a much broader impact on the opioid crisis if it could assist the state in raising awareness to pharmacists and prescribers, as well as decreasing adverse drug events and hospital utilization in patients taking opioids.”
The PDMP serves as a tool for both prescribers and pharmacists to review opioid history, consider total daily dosing of morphine milliequivalents, and identify opportunities to provide high-risk patients with naloxone in case of an accidental overdose.
After initial discussions, the New England QIN-QIO found that the University of Connecticut School of Pharmacy was also interested in utilizing data from the PDMP. The QIN-QIO decided to collaborate with the university to share program data and thereby reduce requests from the PDMP vendor. This enhanced collaboration will enable the New England QIN-QIO to leverage pharmacists-in-training to help educate prescribers and pharmacists, targeting those in communities with high prescribing rates. Ultimately, the program aims to reduce opioid adverse drug events by lowering the rates of total morphine milliequivalents, tablet strength prescribed, daily supply, number of opioids prescribed in the area, and quantity of pills supplied, as well as to increase prescriber and pharmacist PDMP usage.
Moving forward, the New England QIN-QIO plans to expand this approach to the other five New England states leveraging existing data to drive medication safety quality improvement efforts across the region.