1. Prescription Drug Monitoring Program
Kansas Association of Medical Staff Services
November 16, 2018

2. In 2016, there were more drug poisoning deaths since 1999 (632,331) than the number of American military and civilian deaths during World War II (418,500) .

3. The Prescription Drug Monitoring Program (PDMP) in Kansas.
Monitors Schedule II-IV controlled substance prescriptions, as well as drugs of concern dispensed within the state as reported by pharmacies and other dispensers
A web-accessible database, available 24/7, that provides tools to help address one of the largest threats to patient safety in the state of Kansas: the misuse, abuse, and diversion of controlled substance medications
Dispensers electronically report (daily) all controlled substance prescriptions dispensed in an outpatient setting
PDMPs are designed to be a clinical resource and tool, with some access for regulatory and law enforcement
What is K-TRACS
KSA (a): There is hereby created the Prescription Monitoring Program Advisory Committee which, subject to the oversight of the Board, shall be responsible for the operation of the Prescription Monitoring Program.

4. A Prescription Opioid Epidemic
At least 2 out of 100 Kansas adults have used a prescription pain medication without a prescription in the past year.
Data Source: 2015 Kansas Behavioral Risk Factor Surveillance Survey (BRFSS). Available at

5. Education and Information
Education and Information. PDMPs provide useful feedback to prescribers on their own prescribing trends as well as their patients’ controlled substance histories. PDMPs also provide useful information to prescribers when they suspect that a patient may be non-compliant in their controlled substance use.
Public Health Initiative. The public health community can use information from the PDMP to monitor trends and address controlled substance prescribing or utilization problems.
Prevent Misuse, Abuse, Diversion. Prescribers, dispensers, and consumers will be prevented or deterred from participating in illegal drug diversion schemes when a PDMP is in place.
Intervention. Identify patients for assessment and treatment of potential substance use disorder.
Why do we need it?

6. What is K-TRACS
KSA (a): There is hereby created the Prescription Monitoring Program Advisory Committee which, subject to the oversight of the Board, shall be responsible for the operation of the Prescription Monitoring Program.

7. Reporting Who Reports? When and how do they Report?
Dispensers (pharmacies)
Exempt – hospitals for inpatient care, LTC, veterinarians, hospice, methadone clinics
When and how do they Report?
Daily, including zero reporting
Electronically to data clearinghouse
What do they Report?
All CS II-IV and drugs of concern for any Kansan
Exempt – 48 supply from ED; direct patient administration
Reporting

8. Administers VS. Dispenses
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9. Drugs of Concern Changes to KAR 68-21-7 Adding gabapentin
Public Hearing March 8, :30pm
Adding gabapentin
90 days to comply
Current list:
Any product containing all three of these drugs: butalbital, acetaminophen, and caffeine
Any compound, mixture, or preparation that contains any detectable quantity of ephedrine, its salts or optical isomers, or salts of optical isomers and is exempt from being reported to the statewide electronic logging system for the sale of methamphetamine precursors
Any compound, mixture, or preparation that contains any detectable quantity of pseudoephedrine, its salts or optical isomers, or salts of optical isomers and is exempt from being reported to the statewide electronic logging system for the sale of methamphetamine precursors
Promethazine with codeine
Drugs of Concern

10. Advisory Committee Authorized to:
review and analyze data for purposes of identifying patterns and activity of concern
notify the prescribers and dispensers who prescribed or dispensed the prescriptions
notify law enforcement or appropriate regulatory board(s) for additional investigation
may utilize volunteer peer review committees of professionals with expertise in the particular practice to create standards and review individual cases
Shall work with the following groups to develop continuing education programs:
Agencies with oversight of prescribers and dispensers
Kansas Bar Association for attorneys
KBI for law enforcement
Advisory Committee

11. Data Confidentiality Exceptions: No Exception:
Prescribers or Dispensers for purpose of patient care
Patient’s own record request
Regulatory Agencies with oversight of prescribers and dispensers
Law Enforcement
KDHE for Medicaid recipient information
Subpoena or court order in criminal action
K-TRACS personnel for operational purposes
Board personnel for administration and enforcement of PMP Act
Medical examiners, coroners, etc.
No Exception:
Civil proceedings
Requests under the Kansas Open Records Act (KSA et seq)
Data Confidentiality

12. Prescribers
Pharmacists
Delegates
Who should use it?

13. How to Register for K-TRACS

14. Register for an Account

15. Select your User Role

16. Registration Process

17. Submit Registration

18. Validation Documents

19. K-TRACS Report

20. Total Users by Role Physicians 5,388 Pharmacist 4,338
Nurse Practitioner 2,237
Prescriber Delegates 2,058
Physician Assistant 1,046
Dentists
Pharmacist Delegate
Other 1,776
Total 18,138
In 2017, 71.18% of all controlled substance prescriptions reported to K-TRACS were attributed to Active and Registered Kansas Prescribers. Nearly half of those not registered were MDs.

21. July Percent Change in Total KTRACS Users by Year Compared to July 2013
Data Source: Kansas Board of Pharmacy. July 2013, July 2014, July 2015, July 2016, July 2017, and July 2018 running total count of distinct licensure numbers with an active and approved KTRACS account.
Note: KTRACS users were computed as the running total number of distinct state licensure number approved for a KTRACS account for prescribers and pharmacists among currently active KTRACS account.

22. PMPi As of Oct. 2018 Kansas shares with 30 states

23. Health Inc. Article dated July 12, 2018

24. St. Louis County PDMP

25. Threshold Patients The 5/5/90 Rule
Patient has prescriptions from a minimum of 5 prescribers and filled prescriptions at a minimum of 5 pharmacies in less than 90 days
Potential “doctor shoppers”
Multiple provider episodes
Threshold Patients

26. Patient Alert Enhancement

27. Clinical Alerts: Threshold Patients

28. Potential Impact of Threshold Patient Clinical Alert
Data Source: Appriss Health. CDC Grant Measures. KTRACS. Kansas Board of Pharmacy.

29. From 2014 to October 2018
2018
Tableau What I see…

30. Decrease in Opioid prescriptions since 2014

31. Kansas At Risk Age Groups 2018 Opioids Only

32. Kansas Opioid Hot spot map 2018

33. Statewide Integration- CDC Grant
HOW TO INTEGRATE
Statewide Integration- CDC Grant
Complete an “Integration Interest Form”
Review and sign the Terms and Conditions Agreement
Work with your EHR vendor and Appriss to integrate
Reduce barriers to registration and use of K-TRACS
Increase number of prescribers and dispensers using K-TRACS
State will cover all PDMP Gateway® connection costs for each Kansas EHR and PMS approved for integration
Already requested integration:
26 Hospitals
33 Pharmacies
20 Prescriber Practices

34. K-TRACS Integration

35. Statewide Integration

36. Statewide Integration
Data Source: – 2018 User Activity Search Dashboard. Kansas Board of Pharmacy – 2018 PMPi Gateway PDMP Integration Request. Appriss Health. Kansas Board of Pharmacy.

37. Harold Rogers Grant-BJA
How many patients you have prescribed opioids to as well as a comparison to those within your specialty.
Morphine Milligram Equivalent (MME) information is broken out so you can readily see where your opioid prescribing falls within multiple
MME ranges.
Opioid treatment duration, which shows the percentage of patients who have been prescribed opioids for fewer than 7 days, 7 to 28 days, 29 to 90 days, or more than 90 days.
K-TRACS usage, which shows exactly how much you and your delegate(s) are using the PDMP.
Multiple Provider Episodes (MPE) provide a look at the number of your patients who have met or exceeded the K-TRACS threshold of 5/5/90 – five prescribers and five pharmacies within 90 days.
Dangerous Combination Therapy provides you with details of your patient’s combination therapies that may increase a patient’s risk for overdose.

38. Harold Rogers Grant

39. Questions? Reyne Kenton, BA K-TRACS Program Manager
800 SW Jackson, Suite 1414
Topeka, Kansas 66612
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