Promoting the Texas Prescription Monitoring Program
By Susan Kirtz, MPH
Managing Editor, Texas Health Journal
Director of Special Projects, Center for Health Communication
The University of Texas at Austin
It’s a story that we’ve heard over and over again in the news in recent years. A patient recovering from a painful surgery leaves the hospital with a prescription for oxycodone, a prescription opioid pain reliever. At first the pills work to decrease the pain, but over time they have less effect and the patient has to take more and more to manage her pain. A few months later, her primary care physician is surprised to hear that the patient ended up in the hospital due to an overdose.
It turns out that the patient had been obtaining large amounts of the drug prescribed by multiple doctors and filled at several pharmacies around town, with each individual doctor and pharmacy unaware of the others. The lack of communication among prescribers and pharmacies meant that no one recognized what was happening.
This is part of the story of opioid addiction and overdose in Texas (and around the country). In 2015, 1,275 Texans died from an overdose involving opioids, including commonly prescribed opioids (e.g. oxycodone, hydrocodone, etc.), synthetic opioids (excluding methadone), and heroin. The opioid epidemic is one of the foremost public health issues facing the country, and while Texas has one of the lowest overdose death rates nationally, other indicators suggest that Texas is not immune to the issue. Texas has a rising rate of maternal mortality, with data showing drug overdose as a leading cause. Additionally, the number of neonatal abstinence syndrome cases, in which babies are born dependent on a drug, has continued to rise in recent years.
The good news is that Texas prescribers and pharmacies have access to a tool that tracks where and when patients are getting scheduled drugs like prescription opioids. It’s called the Texas Prescription Monitoring Program (PMP).
Managed by the Texas State Board of Pharmacy, the PMP is an online database that collects and monitors outpatient prescription data for all Schedule II, III, IV and V controlled substances dispensed by a pharmacy in Texas or to a Texas resident from a pharmacy located in another state. As the only statewide electronic database that stores all controlled substance information, the Texas PMP helps prescribers and pharmacists avoid potentially life-threatening drug interactions, identify when to make referrals to specialty treatment providers, and identify individuals obtaining controlled substances from multiple healthcare providers and pharmacies.
It can also be used by professional licensing boards to identify or investigate patterns of inappropriate prescribing and dispensing, and to assist law enforcement in cases of controlled substance diversion.
That’s the good news. The bad news is that only 29.6% of physicians are currently registered to use the Texas PMP. Even among those who are registered, many aren’t using it consistently.
Over the next few years, those numbers will change. Texas-licensed pharmacies are already required by state law to report all dispensed controlled substances to the Texas PMP no later than the next business day after the prescription is filled. As of September 1, 2019, prescribers will be required to check the Texas PMP before prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol.
Requiring prescribers to use it, however, is easier said than done. Prescribers need to be informed about the PMP and the upcoming mandate. They need to understand who can use it, and how. Getting to 100% compliance, or even close to that, will take time.
That’s where the Center for Health Communication (CHC) at The University of Texas at Austin comes in. In 2017, the Center was awarded a two-year contract from the Texas Health and Human Services Commission to create and implement a statewide campaign to promote awareness and use of the Texas PMP among prescribers.
Using Health Communication to Promote the Texas PMP
Taking the lead on the project is Dr. Michael Mackert, Director of the Center for Health Communication and Associate Professor in the Stan Richards School of Advertising & Public Relations and Dell Medical School, along with Dr. Kathrynn Pounders, Associate Professor in the Stan Richards School of Advertising & Public Relations and a CHC Affiliate. The CHC partnered with faculty members from the Moody College of Communication, Dell Medical School, College of Pharmacy, School of Nursing, and Steve Hicks School of Social Work to develop and test effective messages and creative concepts.
“This is an exciting opportunity for the Center for Health Communication to do work that will impact the health of people across Texas,” said Mackert. “It's particularly meaningful given the interdisciplinary nature of the project, with faculty from across the university coming together to address a complicated and pressing health issue.”
The CHC team just wrapped up their first year of formative research and delivered preliminary messages and materials to their partners at the Texas Health and Human Services Commission. Their formative research included a literature review, an environmental scan and assessment of how other states promote their prescription monitoring programs, social media listening and analytics, and interviews with key stakeholders.
Overwhelmingly, state administrators reported that the ability to integrate a PMP with electronic medical record systems is a key factor in encouraging use among prescribers, both with and without the presence of a state mandate. Unfortunately, the Texas PMP is not currently integrated with prescribers’ electronic medical records. They have to log in to a separate PMP site to enter the information.
Stakeholder interviews conducted by CHC researchers with Texas prescribers confirmed the results of the environmental scan and revealed significant perceived barriers to using the Texas PMP, such as prescribers’ experience of the PMP as an interruption to their workflow, along with valuable insights about messages that would motivate them to use it.
The CHC team used the results of the formative research to create a variety of preliminary messages and campaign concepts. They then hit the road to test the messages and materials with prescribers around the state - in Tyler, Longview, Pharr, Houston, and San Antonio.
Through the creatve testing, it became clear to the CHC team that prescribers preferred a bold, graphic-based visual style that cuts through the clutter of the multitude of messages and advertisements that bombard them throughout their day. The challenge for the CHC team was to balance this approach with the more conservative brand guidelines of their partners at the Texas Health and Human Services Commission.
The CHC also implemented a social media pilot to help determine which messages garner interest and engagement among relevant audiences. They created a range of Facebook and Twitter friendly images featuring information and data about the Texas PMP. The most commonly liked and shared images presented information about the PMP, such as the most commonly dispensed controlled substances and the percentage of searches completed by physicians. Given the popularity of these messages, the CHC team made a decision to incorporate a PMP data dashboard in the new website.
The team also tested a “pop quiz” concept with questions such as, “When will using the PMP be required?” These images required the user to click through to the CHC website to learn the answer, and were much less popular.
From here, the messages and designs were translated into a range of materials to be implemented in year two of the project, including print and digital ads, along with a new website to serve as a landing page for the Texas PMP login and educational materials.
This summer, the CHC will launch a survey pre-testing potential refinements of the campaign messages. They are also planning a second phase of the campaign, after the September 2019 mandate takes effect, that will focus more on effective use of the Texas PMP as a public health and clinical decision making tool.
The CHC team has learned that marketing to prescribers, especially when you’re promoting a tool with significant perceived barriers associated with its use, isn’t easy. However, they have faith that their careful research and testing, along with the dedication of Texas healthcare providers to protecting the health and wellbeing of their patients and communities, will result in a successful campaign that effectively increases meaningful use of this important tool in helping to end the opioid epidemic in our state.