Advisory Committee Chair
Sue S Feldman
Advisory Committee Members
Tiago K Colicchio
Brent I Fox
Natalyia V Ivankova
Leah J Leisch
Document Type
Dissertation
Date of Award
2023
Degree Name by School
Doctor of Philosophy (PhD) School of Health Professions
Abstract
Background: Many providers continue to over prescribe opioids for pain, and Prescription Drug Monitoring Programs (PDMP) can be used as a tool to assist with appropriate opioid prescribing decisions. Despite mandates requiring opioid prescribers to review patients’ prescribing history in their state’s PDMP, barriers to PDMP success still exist such as a difficult PDMP logon process and having to log on to a separate PDMP system, which can cause access, workflow, time commitment, and ease of use issues and deter providers from using the PDMP. Some health care organizations have implemented PDMP electronic health record (EHR) integration (PDMP EHR-integration) to help overcome these barriers. One type of integration is access integration, where a link to the state PDMP is provided in the EHR as opposed to logging onto a separate PDMP state website. The Task-Fit Technology (TTF) Theory provides insight that the closer a technology fits a user’s tasks, the greater is that individual’s performance. Objective: Using this framework as a guide and given that PDMP EHR-integration is often implemented to reduce the gap between a PDMP user’s tasks and the PDMP technology’s characteristics, this project set out to determine if, and why or why not, PDMP EHR-integration via access integration led to an average reduction in opioid ordering after implementation. Methods: A mixed methods sequential Quant → Qual study design was used. An adapted TTF conceptual model guided both quantitative and qualitative strands of the study. Twelve months of daily, clinical opioid ordering data iii were collected and analyzed for control and treatment groups in the quantitative strand using an interrupted time series approach with an ordinary least squares (OLS) model. These results were used to inform part of the semi-structured, one-on-one provider interview questions in the subsequent qualitative strand. Fourteen providers were interviewed, with 7 in the control group and 7 in the treatment group, and their responses were thematically coded using the TTF theory as an initial guide. A joint display was used to help integrate the results of the two strands and identify meta-inferences. Results: The quantitative results revealed that the intervention had an immediate clinically significant, trending toward statistical significance, increase of 15.933 MMEs per patient per day (p-value: 0.0667) for the treatment group. No over time statistically significant impact was found for the treatment group (p-value: 0.5124), and no immediate or over time statistically significant impact was found for the control group (p-value:0.31, p-value: 0.927). Six themes and 20 subthemes emerged around the conceptual framework’s dimensions of access, use, workflow, and data completeness. The themes identified were Registration/Access Process, Ease of Use, Patient Data, Time Commitment, Validation, and Ordering/Prescribing. Mixing the two study strands led to 24 meta-inferences. Conclusions: Providers chose to use the PDMP to either validate patients’ existing medications or when they intended to order opioids for patients. Most providers in the treatment group felt the integration improved the TTF due to improved access, ease of use, and workflow but not due to a change in data completeness, and they increased their frequency of PDMP use because of these improvements. Many providers in the control group felt that the access, ease of use, and workflow components of using the state PDMP website without the integration link were not issues and did not see a benefit of iv trying to use the intervention. Most providers in both groups experienced or speculated that opioid ordering increased immediately after the intervention due to providers being more comfortable, confident, or feeling more appropriate to order opioids due to using the PDMP more frequently or for the first time after the link was implemented.
Recommended Citation
Martin, Heather D., "Evaluation of a Hospital PDMP EHR-Integration Implementation: A Mixed" (2023). All ETDs from UAB. 365.
https://digitalcommons.library.uab.edu/etd-collection/365
