Changes in Acute Care Use among People with Sickle Cell Disease after Adoption of a Prescription Drug Monitoring Program

• Emergency department visits by people with sickle cell disease declined after the PDMP started, especially after the PDMP mandate began.

• Thirty-day hospital readmissions increased at a faster rate during the PDMP mandate compared to before the PDMP.

Many states require prescribers to check a prescription drug monitoring program (PDMP) database before prescribing controlled substances, which may affect access and health outcomes for individuals with sickle cell disease (SCD). Our study objective was to examine acute care trends before and after PDMP implementation among people with SCD. We carried out a retrospective longitudinal cohort study of 13,698 individuals with confirmed or probable SCD in the Georgia Sickle Cell Data Collection program from 2010-2019. Primary outcomes were monthly rates of emergency department (ED) visits per 1,000 people with SCD; 3-day ED revisits per 1,000 visits; inpatient discharges per 1,000 people with SCD; 30-day readmissions per 100 discharges; and patient days hospitalized per 100 discharges. We observed that, at the start of the PDMP mandate, the volume of ED visits was 12.7% lower during the mandatory PDMP period (RR=0.873 [95% CI, 0.843-0.904]) compared to what pre-PDMP trends would have predicted.  Three-day ED revisits followed a similar pattern. No associations were observed with inpatient hospitalization rate. There was a 0.7% monthly increase in readmissions during the PDMP mandate (IRR=1.007, 1.002-1.013]) compared to 0.1% before the PDMP (IRR=1.001 [1.000-1.001]).  The volume of patient days was higher during the PDMP phase-in period but no different during the mandate. ED use by people with SCD decreased after PDMP implementation, and there was an uptick in the monthly rate of increase in 30-day readmissions after the PDMP mandate. Further research into the impact of opioid control policies on people with SCD is warranted.