Barriers to utilization of prescription drug monitoring programs among prescribing physicians and advanced practice registered nurses at veterans health administration facilities in oregon

Objective. To identify barriers to using state prescription drug monitoring programs (PDMPs) among prescribing physicians and advanced practice registered nurses across a variety of Veterans Health Administration (VA) settings in Oregon. Design. In-person and telephone-based qualitative interviews and user experience assessments conducted with 25 VA prescribers in 2018 probed barriers to use of state PDMPs. Setting. VA health care facilities in Oregon. Subjects. Physicians (N=11) and advanced practice registered nurses (N=14) who prescribed scheduled medications, provided care to patients receiving opioids, and used PDMPs in their clinical practice. Prescribers were stationed at VA medical centers (N=10) and community-based outpatient clinics (N=15); medical specialties included primary care (N=10), mental health (N=9), and emergency medicine (N=6). Methods. User experience was analyzed using descriptive statistics. Qualitative interviews were analyzed using conventional content analysis methodology. Results. The majority of physicians (64%) and advanced practice registered nurses (79%) rated PDMPs as "useful." However, participants identified both organizational and software design issues as barriers to their efficient use of PDMPs. Organizational barriers included time constraints, clinical team members without access, and lack of clarity regarding the priority of querying PDMPs relative to other pressing clinical tasks. Design barriers included difficulties entering or remembering passwords, unreadable data formats, time-consuming program navigation, and inability to access patient information across state lines. Conclusions. Physicians and advanced practice registered nurses across diverse VA settings reported that PDMPs are an important tool and contribute to patient safety. However, issues regarding organizational processes and software design impede optimal use of these resources.