Andrea Wagner, PharmD

Affiliation at the time of project completion: postdoctoral fellow, Rutgers Institute for Pharmaceutical Industry Fellowships

Current affiliation: Novartis Pharmaceuticals Corporation

Rutgers Institute for Pharmaceutical Industry Fellowships

Current affiliation: Sunovion Pharmaceuticals Inc 

Clinical Assistant Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey

The Great Atlantic and Pacific Tea Company 

Professional Experience Program Director and Adjunct Clinical Assistant Professor

Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey 

Research Professor/Fellowship Director— Rutgers Institute for Pharmaceutical Industry Fellowships

Rutgers Institute for Pharmaceutical Industry Fellowships provided financial support to conduct the research survey, prepare a poster, and present the poster at the American Pharmacists Association (APhA) Annual Meeting & Exposition. 

A poster summarizing this research survey was prepared and presented at the APhA Annual Meeting & Exposition in Orlando, Florida (March 28-31, 2014). 

The authors have no conflicts of interest to disclose.

To evaluate New Jersey outpatient pharmacists’ knowledge, perceptions, and commentary regarding the New Jersey Prescription Monitoring Program (NJPMP), an interventional tool used by pharmacists and prescribers that collects prescription data on controlled dangerous substances and human growth hormone.

Prescription drug abuse has emerged as a national epidemic. To combat prescription drug abuse, misuse, and diversion, 49 states, including New Jersey, have implemented prescription monitoring programs. A 6-week, institutional review board—approved cross-sectional survey was conducted.

Licensed New Jersey pharmacists (n = 163) practicing in community, mail order, and hospital/clinic outpatient pharmacy settings completed a voluntary, anonymous online survey.

The electronic survey assessed perceptions of the NJPMP, including accessibility, benefits and challenges to use, and applicability.

Responses were analyzed using descriptive statistics, and free-text comments were summarized by the researchers.

The overall response rate was 36.4% (n = 180). Of the 180 respondents, 163 met inclusion criteria and 92.0% were registered to use the NJPMP. Study results indicated 99.4% of pharmacists were aware of the NJPMP and 81.3% frequently used it in practice. Despite high utilization and knowledge of the program, however, pharmacists identified multiple areas for improvement: increased prescriber use, regional interconnectivity of data, and real-time data reporting.

New Jersey outpatient pharmacists are aware of and in favor of using the NJPMP. Although there was high utilization and knowledge of the program, providing better data access was identified as an overarching area for improvement.

With prescription opioid overdoses leading to more deaths in the United States each year than cocaine and heroin combined, prescription drug abuse, misuse, and diversion have become growing concerns. The Centers for Disease Control and Prevention (CDC) estimated that roughly 12 million Americans (12 years or older) reported illegitimate use of prescription painkillers from 2009 to 2010. Further, there were almost 500,000 emergency department visits and approximately 15,000 deaths annually attributed to prescription painkiller overdoses during that time.

In 2010, there were more than 7200 reported admissions to state-licensed or certified substance abuse programs secondary to the misuse of prescription painkillers in New Jersey alone. This represented a remarkable increase of over 5000 admissions since 2005, or a 230% increase in prescription drug abuse in New Jersey.

 To combat this mounting epidemic, the CDC recommends the implementation of state-run prescription monitoring programs (PMPs) to collect data on prescribing and dispensing of controlled substances.

 The primary goal of PMP utilization is to promote the legitimate use of prescribed medications while curbing fraudulent practices.

	To date, all states, except Missouri, have enacted legislation for PMP implementation.

 Specifically, the New Jersey Prescription Monitoring Program (NJPMP), which can be accessed by pharmacists and prescribers in good standing with their respective licensing boards, monitors data on controlled dangerous substances (Schedules II-V) and human growth hormone (HGH) dispensed in outpatient settings in New Jersey and by out-of-state pharmacies dispensing into New Jersey.

 The NJPMP became operational in 2012 following a 3-phase launch from January through May 2012.

	At the time the survey was conducted (approximately 18 months after launch), pharmacies were required to submit data every 15 days; as of March 2014, pharmacies are now required to submit weekly. This information includes, but is not limited to, data identifying the patient, prescriber, and pharmacy; name, strength, and quantity of the drug; form of payment; date prescription was written; and date dispensed.2 While information submitted is similar across states, reporting requirements vary. For example, Oklahoma pharmacies are required to report in real time, while several others submit daily. Pennsylvania, Connecticut, and Alaska are the only states currently requiring monthly reporting.

	As pharmacists are at the forefront of dispensing medications, it is imperative for the profession to become fully involved in the fight against prescription drug abuse and to better understand pharmacists’ perceptions related to PMPs. A literature search revealed little has been published

 on pharmacists’ use and opinions of PMPs, particularly in New Jersey. While the NJPMP was independent at the time the survey was conducted, it has since joined the National Association of Boards of Pharmacy (NABP) PMP, InterConnect, which links databases from multiple states. As of February 2014, 26 states have enacted memorandums of understanding with the other states to ensure seamless implementation across the involved states.

	The primary objective of the study was to evaluate New Jersey outpatient pharmacists’ knowledge and perceptions of the NJPMP and to capture commentary related to access, barriers to use, and applicability to clinical practice.

	A cross-sectional, nonexperimental survey study assessing New Jersey outpatient pharmacists’ knowledge and perceptions of the NJPMP was conducted over a 6-week period in 2013 (September 2013-October 2013). This study was reviewed and granted exemption by the Rutgers University Office of Research and Sponsored Programs Institutional Review Board. A list of e-mail addresses on file for current Ernest Mario School of Pharmacy (EMSOP) at Rutgers University preceptors practicing in community, mail order, and hospital/clinic outpatient pharmacies throughout New Jersey was provided to the researchers (n = 495).

The following inclusion criteria were utilized for study participation: pharmacists (1) practicing in New Jersey; (2) practicing in community, mail order, and hospital/clinic outpatient pharmacies; and (3) providing consent. Pharmacists were excluded if they were (1) not licensed and/or not practicing in New Jersey, (2) practicing in inpatient settings or the pharmaceutical industry, or (3) not subject to NJPMP reporting requirements (eg, long-term care pharmacists).

	A preliminary survey was developed and pilot-tested by all members of the research team. Based on the pretesting, modifications were made to improve the clarity and intent of the questions. The initial e-mail inviting pharmacists to complete the anonymous, online SurveyMonkey survey was sent on September 12, 2013, and reminder e-mails were sent on October 7, 2013, and October 22, 2013. Due to the blinded nature of the surveys returned, reminder e-mails were sent to all pharmacists on the list, including those who may have already completed the survey. Because no personally identifiable data were collected, it was not possible to preclude participants from completing the survey more than once, although they were asked to disregard the reminder if they had already completed the survey. The survey was closed on October 24, 2013.

	At the beginning of the survey, participants were asked for consent based on introductory language describing the survey and its anonymous format, and they had the option to agree or disagree. The first question was intended to confirm the participant met inclusion criteria by asking whether he or she was a pharmacist currently licensed in New Jersey and practicing primarily in an outpatient setting. For those who responded “No,” the survey ended; for those who responded “Yes,” the survey continued to the second item.

	The survey consisted of 21 items, but employed skip logic methodology; therefore, the number of items that each participant received varied based on their responses, with each participant receiving 1 through 17 items. Respondents were permitted to skip any question and continue with the survey, as each item included the selection, “I choose not to answer.” Response types for the survey questions were a mixture of “Yes/No,” multiple choice, and Likert scale. The final question was free response, inviting the participant to provide any comments regarding the NJPMP. The study survey collected basic pharmacy-related demographic data and information regarding access frequency, knowledge, awareness, and perceptions of the NJPMP, and associated dispensing habits (Table 1). Descriptive statistics were utilized to report data, and comments were summarized by the researchers.

	Responses were collected from 180 participants (response rate, 36.4%). Following the initial question designed to confirm survey eligibility, 17 respondents did not meet inclusion criteria (1 [0.6%] skipped the question and 16 [8.9%] were either not currently licensed New Jersey pharmacists or were not practicing primarily in the community or outpatient settings), 163 (90.6%) met inclusion criteria, and 150 (92.0%) were registered to use the NJPMP. More than half of the respondents had been practicing pharmacy in New Jersey for at least 20 years and over 75% had practiced at least 10 years. The top 3 reported practice areas were chain/mass merchandiser (54.9%), grocery store (22.2%), and independent pharmacy (18.5%). Over 99.4% of the pharmacists were familiar with the NJPMP, and the majority attributed awareness to the New Jersey Board of Pharmacy (NJBOP) newsletter and/or their employers.

	Altogether, 122 respondents (81.3%) were considered frequent users, defined as those who accessed the NJPMP at least multiple times per week (Figure 1). Overall knowledge of the program was rated as good or very good by 89% of subjects, while less than 4% reported poor or very poor knowledge.

	Of the frequent users, the following were selected as common triggers (more than 1 could apply) to using the NJPMP: uneasy feeling (73.3%), new patient (72.6%), medication class (71.2%), patient paying out of pocket (70.6%), and suspicious-looking prescription (65.1%). Response rates for the top 3 categories of prescription drugs that prompt the use of the NJPMP are provided in Table 2. The majority of respondents (83.6%) indicated they would not dispense a prescription if the NJPMP suggested potential misuse (Table 3).

Articles

With prescription opioid overdoses leading to more deaths in the United States each year than cocaine and heroin combined, prescription drug abuse, misuse, and diversion have become growing concerns.