New research has found that real-time prescription monitoring (RTPM) is changing prescribing behaviour – ultimately saving lives.
The study, led by Monash University researchers, is the first Australian research to examine the association between prescription drug monitoring program implementation and changes in multiple prescriber rates.
Key findings after SafeScript introduction (2019):
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The analysis drew on more than 6.7 million prescriptions for over 810,000 patients across 562 Victorian general practices between 2017 and 2023, covering three Primary Health Networks and around 52% of the state’s population.
What difference is SafeScript making?
When SafeScript launched as a non-mandatory system in April 2019, there was an immediate 15% drop in patients seeing four or more prescribers for monitored medicines within a 90-day period, with further declines over the following year. When use of SafeScript became mandatory in April 2020, those reductions were then sustained across 5–6 years of data.
These findings highlight the important role RTPM programs can play in identifying high-risk prescribing, said lead researcher Dr Louisa Picco, Monash NHMRC Research Fellow.
‘Combined with recent evidence of reduced opioid harms following SafeScript’s implementation in Victoria, these results suggest the program is contributing to meaningful improvements in patient safety.’
Professor Suzanne Nielsen MPS, co-author of the study and Deputy Director of the Monash Addiction Research Centre, said the findings add to a growing body of evidence supporting RTPM systems.
‘This research reinforces that real-time prescription monitoring is having a tangible impact, with meaningful reductions in patients obtaining high-risk medicines from multiple prescribers.’
Why addressing multiple prescribing matters
RTPM programs are designed to alert prescribers when a patient has been prescribed high-risk monitored medicines – including opioids, benzodiazepines and stimulants – from four or more doctors within a 90-day period.
Accessing controlled medicines through multiple prescribers is associated with an increased risk of dependence, overdose and death, as well as fragmented continuity of care.
The study found that 96% of multiple prescriber cases occurred within the same clinic, and 85% of multiple prescriber episodes involved at least one opioid prescription. People who were older, male, living in metropolitan areas, or who had a documented substance use disorder were most likely to see multiple prescribers.
Before SafeScript was introduced, identifying these patients was genuinely difficult – even within the same clinic, Dr Picco said.
‘Having visibility over a patient’s full prescribing history for high-risk medicines, via real-time alerts and information within the prescription monitoring programs, can support better continuity of care and we know that’s linked to improved patient outcomes and can ultimately reduce mortality,’ she said.
‘The data shows that after the system’s implementation, patients were more likely to seek care for their monitored medicines from a single prescriber – and we know this is a valuable strategy to help better manage monitored medicines, added PSA’s Head of Policy and Strategy Chris Campbell FPS.
A clinical tool, not a gatekeeper
Dr Picco said that the goal of prescription monitoring programs is to support a clinical conversation, not to restrict patient access to medicines.
For pharmacists, RTPM should be used as a prompt for clinical judgement and conversation, rather than a trigger for refusal of care, Professor Nielsen said.
‘Importantly, the broader evidence reinforces that responses to RTPM alerts need to be patient-centred and measured, avoiding abrupt changes that may lead to unintended harm,’ she said.
Working even where compliance isn’t perfect
While the research highlights that RTPM systems are delivering population-level benefits, coronial findings have previously identified that compliance with real-time prescription monitoring is not optimal in some settings.
‘We hear from the profession that more can be done to improve the operation of these systems in protecting patients, but it is reassuring to see data that these systems are absolutely making a difference to patient safety – saving lives and reducing adverse events as a result of medicines,’ Mr Campbell said.
‘It is important to note that the Victorian system is mandatory, and while there remain opportunities for these systems to have an even greater impact, this data adds to our understanding that even where systems are not working perfectly, they are making a real difference.’
Professor Nielsen said pharmacists have an important role to play when RTPM alerts arise.
‘Pharmacists are well placed to lead conversations with both patients and prescribers when alerts arise, ensuring care is safe, consistent and collaborative,’ she said.
‘There is also a need for clearer guidance and support for pharmacists on how to respond to RTPM alerts, particularly in complex cases where multiple prescribers may be clinically appropriate.
‘Ultimately, maximising the benefit of RTPM will depend on embedding it into a broader approach to care that prioritises continuity of care, reduces stigma, and supports gradual, patient-centred responses to high-risk medicine use.’
Access the Real-Time Prescription Monitoring chapter of PSA’s Digital Health Guidelines For Pharmacists to learn more about best practice.
