Researchers say the findings point to improved patient safety and continuity of care.
Victoria’s prescription drug monitoring program SafeScript has been linked with a significant reduction in patients being prescribed high-risk medicines such as opioids and benzodiazepines by multiple doctors, researchers say.
They said patients who saw multiple doctors for high-risk medicines faced increased risks of dependence, overdose, and death, as well as reduced continuity of care.
The study, published in the Medical Journal of Australia, analysed more than 6.7 million prescriptions for over 810,000 patients across 562 general practices in Victoria between 2017 and 2023, covering three Primary Health Networks representing about 52% of the Victorian population.
It is the first Australian study to examine the association between prescription drug monitoring program (PDMP) implementation and changes in multiple prescriber rates.
“We demonstrated that implementation of the Victorian prescription drug monitoring program was associated with meaningful reductions in people obtaining monitored medications from four or more prescribers,” the researchers wrote.
In Australia, prescription drug monitoring programs alert prescribers when a patient has been prescribed high-risk monitored medicines – including opioids, benzodiazepines, and stimulants – from four or more doctors within a 90-day period.
PDMP implementation commenced on 1 April 2019. Use was voluntary for the first year and became mandatory on 1 April 2020. All community-based prescribers and pharmacists are now required to check the PDMP before prescribing and dispensing monitored medications.
The Victorian PDMP is commonly integrated into prescribing and dispensing software and utilises a back-end computerised algorithm that triggers a notification and alert system.
Pop-up notifications appear in the prescribing or dispensing software, informing clinicians whether there are records that need to be reviewed within the PDMP.
The research team, led by Monash NHMRC Research Fellow Dr Louisa Picco, found that when SafeScript was introduced voluntarily in April 2019, there was an immediate 15% drop in patients seeing four or more prescribers for monitored medicines, with further declines over the following year.
When use became mandatory in April 2020, these reductions were sustained. The study also found that 96% of multiple prescriber cases occurred within the same clinic.
“Interestingly, following mandatory PDMP implementation, no further significant reductions in multiple prescriber rates were observed, relative to voluntary use, suggesting that much of the observed change occurred during voluntary use, potentially due to a range of factors,” the researchers wrote.
“For example, unlike US PDMPs, which were implemented to identify patients with high-risk behaviours and prescribers undertaking suspected fraudulent prescribing, Australian PDMPs focus on identifying patients engaging in high-risk behaviours.
“During the one-year voluntary implementation period, the focus centred on clinical responses to high-risk behaviours, which may have provided considerable time for uptake, and may explain the limited changes following mandatory implementation. Impacts relating to Covid-19 may have also contributed to this finding.
“Further research is needed to assess other possible contributors, including changing clinician engagement and alert fatigue.”
The researchers found that 85% of multiple prescriber episodes involved at least one opioid prescription, and people who were older, male, living in metropolitan areas, or who had a documented substance use disorder were most likely to have been seeing multiple prescribers before SafeScript was introduced.
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Dr Picco said the findings point to clear benefits of prescription monitoring for patients prescribed high-risk medicines.
“These findings highlight the important role prescription drug monitoring programs can play in helping doctors identify patients receiving high-risk medicines from multiple prescribers,” she said.
“Combined with recent evidence of reduced opioid harms following SafeScript’s implementation in Victoria, these results suggest the program is contributing to meaningful improvements in patient safety.”
Dr Picco said that before SafeScript, it was difficult for prescribers to identify when multiple doctors were prescribing high-risk medicines to the same patient, even within the same clinic.
“Having visibility over a patient’s full prescribing history for high-risk medicines, via real-time alerts and information within the prescription monitoring programs, can support better continuity of care and we know that’s linked to improved patient outcomes and can ultimately reduce mortality,” she said.
“The goal of these alerts is to support a clinical conversation, not to cut people off from their medication.
“Abrupt changes to a patient’s treatment have been linked to serious harms, including overdose and transition from prescription to illicit drugs.
“Gradual, patient-centred approaches are essential.”
Victoria was the first Australian jurisdiction to mandate real-time prescription monitoring. Following SafeScript’s implementation, independent evaluations have found reductions in deaths attributed to monitored medicines and in prescription medicine-related hospitalisations.
The research was a collaboration between Monash University, Turning Point, and Monash Health, and was funded by the Australian National Health and Medical Research Council.
