Queensland coroner calls for real-time doctor shopping system

A Queensland coroner has echoed counterparts in Victoria and South Australia in calling for a new system to enable real-time access to relevant prescription and doctor attendance history following the death of another person from an accidental overdose of prescription drugs.

Brisbane coroner Christine Clements yesterday released a report into the death of Katie Lee Howman in late 2013 from an overdose of the opioid fentanyl.

Ms Howman, a critical care nurse at Toowoomba Base Hospital, was known to the Australian Health Practitioner Regulation Authority (AHPRA) and was under supervision and restrictions regarding access to certain drugs after self-administering fentanyl at work in 2010.

While she was never prescribed fentanyl and appears to have sourced it from work, she did suffer from chronic pain, depression and anxiety and had been appropriately prescribed opioid painkillers such as tramadol and oxycodone by her regular GP.

However, between the 2010 episode and her death in 2013, she had visited 30 other doctors and numerous pharmacies in the Toowoomba area. This included 20 different doctors and 15 different pharmacies in the 13 months between October 2012 and November 2013.

“It was during these visits that she obtained 71 prescriptions providing her with 1705 doses of oxycodone,” the coroner reported. “In those last three months she had also obtained prescriptions for 340 doses of tramadol.”

Her long-standing GP was not aware of her behaviour and the coroner found that he had prescribed appropriately. However, she also found that only one of the 30 doctors Ms Howman visited had suspected she was doctor shopping and checked with Queensland Health's Medicines Regulation and Quality unit, which provides advice to doctors if they have detected a pattern of obtaining prescriptions which raises concerns about dependency.

The MRQ unit can also assist doctors with information on a patient's history for controlled drugs, whether the patient is consulting other doctors, whether they are on an opioid treatment plan, their drug dependence status and whether other GPs have raised questions about the same patient.

The coroner also pointed to Medicare's prescription shopping information service, which can identify in any given three-month period if a patient has consulted six or more doctors for PBS prescriptions or has obtained 25 or more PBS prescriptions for controlled drugs or drugs of dependence.

“The tragedy is that there was an undeniable record of [Ms Howman's] growing dependency and reckless behaviour in accessing prescriptions for opioids,” Ms Clements reported. “She was doctor shopping within the wider Toowoomba area and beyond, sourcing oxycodone as well as tramadol.”

However, Ms Clements said one deficiency in existing information systems is that they are reliant on a doctor or pharmacist forming a suspicion that then prompts a request for information, and the information is not available in real time.

She pointed to Tasmania and the NT, which she said were both using real time information software retrieval systems to inform decision making, and the New Zealand model, where information of concern was sent to the treating doctor rather than relying on the doctor to contact the information service.

“There is undoubtedly a huge human and fiscal cost in the way the Pharmaceutical Benefits Scheme is currently being misused to source and subsidise controlled drugs and drugs of dependence,” she said.

“There have been many previous inquests throughout Australia that have highlighted deaths due to overdose, usually inadvertent, of people who have developed a dependency on prescribed medication. Countless more deaths have been reported to coroners where findings have been made without a public inquest.

“And there have been repeated previous recommendations made by coroners to improve the real time accessibility of information for doctors and pharmacists about their patient’s prescription history.”

She strongly recommended that there be statutory change to enable real-time access to relevant prescription and doctor attendance history.

“No doubt there would be ways to accommodate privacy issues while still safeguarding patients from harm and the abuse of a publicly funded resource. These matters should be urgently investigated and considered by government.”

Posted in Australian eHealth

Comments   

# Steve Hambleton 2015-07-29 12:13
If she had a PCEHR and the prescribing doctors were connected to it Best Practice and Medical Director (at least) would be automatically uploading prescribing information. If the pharmacies were connected they would be uploading dispensing information and there would been another opportunity for any one of the pharmacies or GPs to constructively intervene. For a long term pain patient opting out to prevent the above would raise my suspicion too. Steve H
# Margaret Millington 2015-07-29 14:51
My family & I have been campaigning for the implementation of a Real Time Monitoring System, Nationwide due to our son becoming an 'accidental addict' to Pharmaceuticals after he suffered life threatening injuries in a single car accident in 1994. We have addressed a Parliamentary Inquiry, appeared on TV and in the printed media, written endlessly to politicians and joined forces with Scriptwise in our quest for change. We are continually told it is being 'investigated' , meanwhile innocent people continue to die. Our son Simon became one of these statistics following his death from an overdose which included his drug of choice, oxycontin in 2010. We must try to become one voice for change Australia wide!! Margaret Millington
# Anna McMahon 2015-07-29 22:31
there are hundreds of families seeking for prescription drug issue to be addressed. Not to mention hundreds of organisation seeking to address this issue.
Meanwhile there are hundreds if not thousands of patients every day struggling with prescription drug addiction and their families watching, helpless to do anything.
Every year there are 350 plus people dying of prescription drug adverse events.
We have the Real Time Prescription Monitoring System. It's already used by a number of general practices.
We have hundreds of doctors registering for the RTPM to be installed, at their clinics.
Doctors understand the need for real time prescription RTPM system and are embracing the product, helping them to make informed decisions at the point of care.
We all know some one whom has been effected. We need to work together to fix this epidemic.
Happy to provide more details how you can install the product and be part of the change.
# Michael 2015-07-30 15:40
The problem with the PCEHR is that people that doctor shop are smart enough to not have one or will not record events on it that may point to the activity.
# Jane Connolly 2015-07-31 11:33
I'd be interested in hearing more Anna about the system you are referring to.

Quoting Anna McMahon:
there are hundreds of families seeking for prescription drug issue to be addressed. Not to mention hundreds of organisation seeking to address this issue.
Meanwhile there are hundreds if not thousands of patients every day struggling with prescription drug addiction and their families watching, helpless to do anything.
Every year there are 350 plus people dying of prescription drug adverse events.
We have the Real Time Prescription Monitoring System. It's already used by a number of general practices.
We have hundreds of doctors registering for the RTPM to be installed, at their clinics.
Doctors understand the need for real time prescription RTPM system and are embracing the product, helping them to make informed decisions at the point of care.
We all know some one whom has been effected. We need to work together to fix this epidemic.
Happy to provide more details how you can install the product and be part of the change.
# Jane Connolly 2015-07-31 11:40
I agree with Michael that a PCEHR record would not work in this situation with the patient's choice to opt in or opt out. However we do have a national medicines terminology to standardise coding of medicines and the PBS coding. Along with a national healthcare identiifer for a patient and a national prescription repository we are now in a position to easily establish a tracking and alert system for drug dispensing in Australia. I would support the design to have a 'push' notification at the point of prescribing, rather than having to submit a request for information.
# Kate McDonald 2015-07-31 13:38
Hi Jane

It's called Dr Shop and it's available now, but only to GPs using the MediSecure prescription exchange service. We've covered it here: http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2196:medisecure-set-to-launch-real-time-prescription-monitoring-system&catid=16:australian-ehealth&Itemid=328

and here: http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2234:medisecure-to-launch-drshop-service-in-next-bp-update&catid=16:australian-ehealth&Itemid=328
# Anna McMahon 2015-08-01 20:55
It's called DrShop, which is a real time prescription monitoring system at the point of care. A alert is generated if the patient has been prescribed a schedule 8 and/or 4. There has been a pilot running for 6 months in Victoria. it has identified a number of Doctor Shoppers, allowing doctors to provide alternative care. There are over 6000 doctors waiting for the program to be implemented on to their PC. The tool allows the doctors to be able to make an informed decision for their patients.
It's time for doctors to be able to take control this tool is the first positive step for them. I'm sure they don't want to make the wrong decisions, and cause harm and death to their patients.
The URL is in Kates response, the government is to slow, all of the state coroners have recommended for this tool. It real time and DrShop, is the only tool that has real time.
It's time we stand together and fix this prescription drug problem. The deaths have increased every year, and the addiction out there is so preventable.
I have been advocating for 13 years for government to act, as they can make the change.
The benefits to implement the real time prescription monitoring tool, will save millions of dollars for the PBS, doctors insurance claims reduced, doctors can feel comfortable when prescribing, patients can be placed on Alternative health programs, families do not have to watch on while they slowly become depended or die. Pharmaceutical companies may not support this change as they loss money.
# Anna.McMahon 2015-08-02 09:20
We can all support this change, doctors just need to register, at the MediSecure site, for doctor shop to be installed.
DrShop has no cost associated to it.
I have been advocating for 13 years for change. Which means 13 years X 300 plus , people have died each year due to prescription drugs this equates to 3900 people whom have died and this is totally preventable.
I feel sad l for all the families, they have to live with this loss every day, we just let it happen.
We need the government to take control of this change.
Health care is there to CARE for the patients, let's help the doctors.
This small change will have a huge impact, with very little effort.

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