Prescription drug monitoring programs – why are clinicians cautious of this digital health tool and data?

Background: Prescription drug monitoring program (PDMP) systems are used internationally to monitor and reduce harm from high-risk psychoactive prescription medications that are often implicated in prescription shopping, diversion, misuse, and overdoses. PDMP systems facilitate tracking of medications and trigger alerts to assist clinicians in identifying high- or at-risk patients. Systematic reviews have shown varied results with respect to PDMP systems improving prescribing, dispensing, and safety outcomes. Poor uptake of PDMP technology appears to be a key factor contributing to failure to achieve benefits. Aim: To collate findings from process evaluations of PDMP to identify the main barriers and facilitators to adoption of these systems.Methods: A systematic review was conducted to identify all systematic reviews of PDMP published after 2015.Results: Only four reviews of PDMP process evaluation studies were identified, all conducted within the United States. Process outcomes examined varied across studies, but in all cases PDMP was underutilised by health care providers. Positive attitudes towards PDMP and knowledge of PDMP positively influenced the likelihood of PDMP use. One review identified a large number of barriers (n=142) and facilitators (n=183) to PDMP which related to information quality, use, intention to use, and user satisfaction. Low PDMP implementation rates related to PDMP infrastructure and data availability challenges.Conclusions: There is a paucity of research comprising process evaluations of PDMP systems. To understand how and why these systems are achieving or not achieving anticipated outcomes, more studies are needed which assess and describe PDMP use and user experience, including in Australia