Telehealth and Controlled Substance Prescribing Adds a Whole New Level of Stress

Telemedicine has become a mainstay in the current environment of Covid. This creates a host of problems for prescribers.

Telemedicine has become a mainstay to evaluate patients in the current environment with the widespread of Covid-19.  Although the Corona Virus will hopefully pass soon, it seems that telehealth is here to stay for vulnerable patients, such as the immunocompromised, immobile, or elderly.  Controlled substances are a common form of medical treatment for chronic conditions in these populations, and several challenges exist when prescribing these drugs. Telehealth is challenging as it is, and when a provider has to prescribe opioid analgesics, benzodiazepines, and stimulants, the situation becomes more complicated for the following reasons:

During telehealth encounters, the office staff is unable to properly observe behavioral patterns and pay attention to how a patient interacts with the other patients or medical office staff in the waiting room.

  • Pain always has a subjective component, which means that the prescriber needs to take several matters into consideration, which starts as soon as the patient enters the provider’s office.  
  • Identifying drug seeking patients can be challenging. Drug seekers tend to have volatile emotions, get angry quickly, and can cause commotion in the office.  It is imperative to recognize and identify aberrant behavior, which is difficult to ascertain in a telehealth visit.  
  • Limiting the prescriber to a screen without observation of behavior traits is a challenge when prescribing controlled substances.

Conducting a thorough physical examination is typically protocol in ruling out malingering behavior, which requires some creativity during telehealth encounters.

  • Unable to properly check for point tenderness, thorough palpation, and gait analysis.
  • Difficult to identify particular aspects of the physical examination over a screen.
  • Unable to fully evaluate for needle or track marks accurately.

The inability to properly observe behavior patterns, as this typically occurs in a waiting room.

  • Chronic pain patients often abuse their prescription drugs. In order to identify patients who are taking more medication than prescribed, it is crucial to observe the patient over some time for increased somnolence, slurred speech, and altered affect.
  • Drug abusing patients often obtain medications from other patients, offer money for drugs, or are found selling or trading controlled substances.

Inability to call the patient in for random urine toxicity or pill count.

  • Sending them to the lab has the same risks as coming into the office during the pandemic, so this crucial step is now missing in the current environment.
  • Patients often need supervised random urine testing if there are any suspicions of drug-seeking behavior.

Accurate documentation when prescribing controlled substances is always challenging, and documentation of the patient-provider encounter during telehealth visits creates a new level of stress.  

  • Pre-visit, visit, and post-visit documentation: PDMP analysis, diagnostic tests, history of present illness, PEG score, patient input, compliance checking, and medication reconciliation, must be properly documented.

At Scriptulate, we take pride in providing the prescriber the proper tools to identify addiction early, providing access to the essential information necessary during a patient encounter, and validate compliance and due diligence. We understand the difficulties of attempting to properly document the patient encounter while ensuring compliance, which is exceptionally challenging while treating patients on daily controlled substances within a limited timeframe. Our platform with checklists and time-stamped documentation can streamline the documentation process.

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