Healthcare providers beliefs about the meanings and impacts of prescription drug monitoring program alerts

Background: Addiction and overdose death associated with high-risk prescription medications such as benzodiazepines and opioids, are significant global issues. Prescription Drug Monitoring Programs (PDMP), which allow healthcare providers to track and monitor patients’ high-risk medication history have been implemented widely throughout North America and recently in Victoria, Australia. Australia’s PDMP uses a red alert notification to notify healthcare providers to patients at ‘high risk’ of medication related harm. Very little is known about healthcare providers beliefs about the meaning of these notifications and what impact these meanings have on the clinical encounter and patient outcome. Methods: Twenty-nine interviews with Victorian healthcare providers (15 prescribers and 14 pharmacists) were thematically analyzed. Results: Red alerts were understood as being both synonymous with addiction, as well as a single data point with further investigation required to draw conclusion from. The red alert both disrupted and exposed underlying addiction stigma. Healthcare providers assumptions about patient’s readiness to change influenced their decision to discuss the red alert with patients. Conclusions: How healthcare providers make sense of and response to PMDP generated red alerts can impact upon the clinical encounter, including clinical decision-making and the care that patients receive. By identifying and understanding the social factors and forces driving beliefs, attitudes and behaviors toward people who use addictive prescription medications, healthcare providers may be able to pause, assess and reflect on how these factors shape their decision making in unhelpful or unethical ways.