Real-time script monitoring has finally reached WA and doctor groups are cautiously optimistic it will achieve its goal to stop doctor shopping.
Cathy O’Leary reports
WA health authorities are being urged to take a nuanced approach to compliance with its new digital tool to crack down on patients ‘doctor shopping’ for drugs of addiction.
This follows the launch in March this year of the State Government’s ScriptCheck WA platform, which is modelled on systems already used in some other States.
Doctor shopping is a growing problem across Australia, driven by addiction and abuse of controlled medicines, with people typically visiting different doctors over time to obtain multiple prescriptions for drugs such as oxycodone.
The Government claims the new real time monitoring platform will be a gamechanger for doctors and pharmacists.
Royal Australian College of GPs’ WA chair Dr Ramya Raman told Medical Forum that while she supported the new system, she urged the WA Health Department to take an educative rather than punitive approach if some GPs had difficulties complying with it.
About 5000 prescribers in Queensland received an email earlier this year saying they had forgotten to check the State’s real-time prescription monitoring system, QScript, before prescribing a monitored medicine.
While health authorities there said the letters were intended to be educational and not punitive, they did not include basic details such as the dates or patients for whom the practitioners had allegedly failed to check QScript when the letters were emailed out at 8pm on a Friday evening.
“ScriptCheck WA has the potential to be a very useful mechanism to help GPs make safer clinical decisions about which medicines to prescribe, and to reduce the risk of patients ‘doctor shopping’ to access drugs such as opioids and benzodiazepines, which can have adverse outcomes,” Dr Raman said.
“But in implementing ScriptCheck, the Health Department must ensure that it is straightforward for GPs to use, including the practicalities of integration into practice clinical software.
“We have seen from other jurisdictions including Queensland that this has not always been the case, with GPs receiving emails late on a Friday and being ‘pinged’ at times when the site had actually crashed.
Site ‘freezes’
“GPs in that State also reported that the site regularly freezes and that they often have to manually go in and check a box when trying to enter a prescription.”
Dr Raman said enabling a good user interface with GP software was key to ensuring the system was effective for improving patient outcomes.
Australian Medical Association WA president Dr Mark Duncan-Smith agreed that ScriptCheck was in principle a great idea and in general terms should be supported.
“ScriptCheck ‘should’ save time, assist with identifying drug-seeking patients quickly and identify patients who may need counselling regarding their drug or prescription use,” he said.
“However, the ‘should’ is yet to be determined if practically it will achieve these goals.
“ScriptCheck must integrate seamlessly with practice software to be user friendly and be efficient for the user. If this does not occur, it will not be used and not achieve these goals.”
Given these provisos, he said ScriptCheck could save a lot of time with the potential ‘drug seeker’ patient, especially if they were “less than truthful.”
“It will allow more accurate identification of ‘drug seeking’ patients so the conversation can be better directed rather than spent identifying if the patient is drug-seeking,” he said.
ScriptCheck has been released to all GPs and community pharmacies throughout WA, after undergoing testing with a select group of doctors in the first two months of this year.
There is a series of three modules to train prescribers and pharmacists on the use of the WA system, with the first module detailing the functionality of real-time prescription monitoring and its safety benefits.
The second module has a focus on safe and appropriate dispensing of monitored medicines and managing concerns about patient safety regarding the use of monitored medicines.
The third module details best practice communication strategies to help prepare for conversations with patients about monitored medicines.
Drugs reported in the platform include controlled drugs for the treatment of severe pain, such as opioids (morphine, oxycodone, fentanyl and methadone) and stimulants such as dexamphetamine for the treatment of ADHD.
Health Minister Amber-Jade Sanderson said the Health Department would closely monitor the outcomes of ScriptCheck and consider adding other problematic prescription medicines to the system.
“Early users of the system say it has vastly improved the way they can support their patients and manage any risks in relation to these medications,” she said.
“The platform allows doctors and pharmacists to instantly detect doctor shopping – meaning they can intervene where people are accessing excessive amounts of these medicines.
“The strength of the new ScriptCheckWA system is that it now gives health practitioners instant, secure access to this data, as it occurs.”
Ms Sanderson said better access to this data would allow the rapid identification of people with a drug problem and help get them referred to a drug treatment program.
Victoria became the first Australia State to introduce mandatory real-time prescription monitoring, launching SafeScript in 2020, which was followed by similar systems in other jurisdictions including Queensland and South Australia.