Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers.

Abstract

OBJECTIVE\nTo explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.\n\n\nDESIGN\nMixed-methods study with survey collection and semistructured interviews.\n\n\nSETTING\nMultiple academic hospitals in New York.\n\n\nPARTICIPANTS\nOne hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews.\n\n\nINTERVENTIONS\nIntroduction of IStop.\n\n\nMAIN OUTCOME MEASURE(S)\nChange in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and comanagement) as reported by primary care providers for patients with chronic pain.\n\n\nRESULTS\nAfter the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management comanagement with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and comanagement (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management.\n\n\nCONCLUSIONS\nAfter the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.