Safe Prescribing to Prevent Misuse and Diversion March, 2014 edition MAPS – The Michigan Automated Prescription System Jim Middleton, BSPharm, MCTE Additional data interpretation and assembly by Janeille De. Vore, CPh. T, PA candidate Miller College BSRN candidates (Spring 2014)
A Tale of Nine Cities - 1 Battle Creek, Michigan Population: 92, 270 Avg House Value: $80, 300. 00 Avg Household Income: $38, 231. 67 Median Age: 38. 73
A Tale of Nine Cities - 2 Kalamazoo, Michigan Population: 158, 937 Avg House Value: $99, 416. 67 Avg Household Income: $36, 775. 50 Median Age: 31. 69
A Tale of Nine Cities - 3 Watervliet, Michigan Population: 5, 966 Avg House Value: $84, 600. 00 Avg Household Income: $40, 187. 00 Median Age: 40. 00
A Tale of Nine Cities - 4 Hastings, Michigan Population: 19, 127 Avg House Value: $99, 100. 00 Avg Household Income: $44, 440. 00 Median Age: 40. 50
A Tale of Nine Cities - 5 Marshall, Michigan Population: 14, 646 Average House Value: $109, 300 Avg. Income Per Household: $45, 961 Median Age: 42. 90 years
A Tale of Nine Cities - 6 Traverse City, Michigan Population: 70, 019 Avg House Value: $135, 650. 00 Avg Household Income: $43, 663. 50 Median Age: 42. 45
A Tale of Nine Cities - 7 Grand Rapids, Michigan Population: 348, 860 Avg House Value: $116, 090. 91 Avg Household Income: $44, 156. 18 Median Age: 33. 92
A Tale of Nine Cities - 8 Detroit, Michigan Population: 673, 342 Avg House Value: $59, 284. 00 Avg Household Income: $28, 052. 88 Median Age 35. 76
A Tale of Nine Cities - 9 Six Lakes, Michigan Population: 2, 116 Avg House Value: $72, 800. 00 Avg Household Income: $32, 672. 00 Median Age: 41. 50
The General Categories Stimulants (any product containing methylphenidate, amphetamine, or its chemical cousins) Hydrocodone-based products Oxycodone-based products Methadone
How the Data Was Examined For the years 2007 and 2011, all controlled substance data was examined, by zip code of the chosen cities, from the MAPS website The four categories were summarized as the number of doses dispensed for those respective years The number of doses was then divided by the census for that city, based on those zip codes, using the US Census of 2010
This resulted in “Per Capita/year” consumption data This means, essentially, if each of these cities had only one pharmacy, and that pharmacy was only open one day each year. . . the entire population of that city could stand in line at that pharmacy, and, regardless of age or physical condition, Obtain this number of tablets in that particular drug category
For Example, in Grand Rapids In 2007, each person could get 10 stimulant tablets (ie Ritalin or Adderall) for that year In 2011, that quantity would be 14 for each inhabitant of the city of Grand Rapids All 348, 860 inhabitants
MAPS Comparison – Nine Michigan Cities Hydrocodone Based-Per Capita Year
Some Hydrocodone“also-rans” from 2011
More Methadone “also rans” from 2011
Some Surprises Why is Six Lakes, population 2116, close to hydrocodone consumption after Detroit? And Watervliet? What of that huge jump in stimulant use between 2007 and 2011 in Detroit? Artifact? Some dips in consumption – ie, oxycodone product use in Marshall between 2007 and 2011
Obviously, there are limitations to this method of inspection Populations change (Detroit lost nearly 35, 000 in 2010 -2012 alone) 2010 census data was employed The MAPS program in 2007 was challenged by technical and compliance issues – note the odd Detroit numbers for that year
However, it's a starting point This data also can tell us which specific zip codes are using Oxy. Contin 30 mg over other strengths (there a LOT of zip codes – Detroit has over 25) Opana vs Oxy. Contin use? It can generate other questions – why are Zydol and Xodol popular in one region but essentially unused elsewhere? What are the consequences to the water supply in areas of high CS consumption?
Using MAPS On line system Yields results in 2 -3 minutes (fastest 90 seconds) Requires registration Paper reports are available for remote areas without computer access, but that's quite a delay
Multiple States Involved Arizona, Connecticut, Indiana, Kansas Mississippi, North Dakota, Ohio South Carolina, Virginia, West Virginia Conspicuous by its absence: Missouri – only state without a controlled substance prescription database
Where Does the Data Come From? “Dispensing practitioners” Pharmacists, certain clinics, veterinarian offices Data reported to MAPS every other week, but it is more often becoming weekly and even daily Go to www. michigan. gov/lara > health professions > MAPS “Statistics” gives zip files of spreadsheets
When do pharmacists use it? New patients “Patients exhibiting erratic behavior” New patients requesting specific brands and claiming not to have insurance Patients using 'Pain Contracts'
A Sample MAPS Report
Can MAPS reports be shared among practitoners? No! You cannot ask a pharmacy to run one on your behalf! You have to get your own! And it's only supposed to be YOUR patient. It is important that if delegated professionals (ie P. A. s and N. P. s) are ordering controlled substances that THEIR DEA number appears on the prescription.
It's not perfect Some limitations to the number of reports per day – a software challenge The users drive investigations as much as the administrators Patients with fake I. D. s, birthdate challenges CIVs (ie benzodiazepines) currently available only as statewide data, not by zip code, before 2013
But it's what we have The administrators are receptive to your input, and respond within a short time to email questions CIVs are available as of March 2014! The more it is used, the more it will be considered a valuable tool to be maintained
Contact for questions and suggestions regarding MAPS program in Michigan: mapsinfo@michigan. gov
Скачать презентацию Safe Prescribing to Prevent Misuse and Diversion March
8feb3459e3d6cde16e3f00fa87e7ed7f.ppt