Form Section A: Rx Section A: Rx Section A: Rx

Strategic Prevention Framework for Prescription Drugs (SPF‑Rx)

Unique Questions – SPF Rx

Instructions for Using the Unique Questions for the SPF Rx Program

In this tool, all SPF Rx-specific substitute or additional text is captured in RED. All additional SPF Rx-specific items are captured in RED tables. These RED text blocks and items should be inserted into the Division of State Programs- Management Reporting Tool (DSP-MRT). The technical notes found throughout the tool show where in the DSP-MRT the additional text or items should be inserted into the DSP-MRT Wireframes document.

Contact Information

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Needs Assessment

Needs Assessment Upload

NOT REQUIRED FOR SPF Rx; GATHERED IN DSP MRT – NO UNIQUE ITEMS

Accomplishments and Barriers/Challenges

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Capacity

Membership

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Advisory Council and Other Workgroup Meetings

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Other Opioid-Specific Workgroup Activities

Use this section to enter information about opioid-specific workgroups outside of your State/Tribal Epidemiological Outcomes Workgroup (SEOW/TEOW). Information about SEOW/TEOW is reported in a separate section. The section includes questions regarding leveraging resources, including state-/grantee-level opioid workgroups and grantee-level funding resources. Note

Item	Type of Item/ Response Options	Technical Notes
Do you have a state-/grantee-level opioid workgroup?	Radio buttons: Y/N	Responses will be carried over across reporting periods. Grantees can edit if needed.
Does your opioid workgroup serve as your SPF-Rx Advisory Council?	Radio buttons: Y/N	This item will only appear if Yes is selected for the first item in this section. Responses will be carried over across reporting periods. Grantees can edit if needed.
Does a state/grantee-wide strategic plan exist addressing opioid issues, including prevention of misuse, treatment, and overdose prevention?	Radio buttons: Y/N	Responses will be carried over across reporting periods. Grantees can edit if needed.
Is there an opioid-focused taskforce out of your governor’s office?	Radio buttons: Y/N	Responses will be carried over across reporting periods. Grantees can edit if needed.
How has the opioid-focused taskforce out of your governor’s office informed the SPF-Rx project?	Free text	This item will only appear if Yes is selected for the previous item in this section.
Is your SPF-Rx strategic plan integrated into or harmonized with the state/grantee-wide opioid strategic plan?	Radio buttons: Y/N	This item will only appear if Yes is selected for the first item in this section. Responses will be carried over across reporting periods. Grantees can edit if needed.
Have you engaged in efforts to coordinate opioid funding streams during this reporting period?	Radio buttons: Y/N
Please describe your efforts to coordinate opioid funding streams during this reporting period?	Free text	This item will only appear if Yes is selected for the previous item in this section.

Grantee Funding Resources

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Other Resources

>Policies, Regulations, and Laws

Use this section to enter information regarding the existence of policies, regulations, and laws related to prescribing or dispensing opioids in your state, tribal area, or jurisdiction. Once you complete this section, you will only update it if there are any revisions or additional changes related to your policies, regulations, or laws.

Item	Type of Item/Response Options	Technical Notes
Indicate if guidelines/regulations currently exist in your state/jurisdiction related to any of the following: Required universal prescriber registration with the PDMP	Radio buttons: Y/N	Section is inserted after Page ID 2.2.3.1
Doctors can assign authorized delegates to access the PDMP	Radio buttons: Y/N
Requirements for prescribers to query PDMP before prescribing opioids in certain conditions (e.g., for more than short-term use)	Radio buttons: Y/N
Pharmacists have a set time frame for uploading opioid dispensing data	Radio buttons: Y/N If yes, what is the time frame for uploading opioid dispensing data? (open text box)
PDMP patient records and electronic health records are linked in at least one large health care system	Radio buttons: Y/N
PDMP records are linked with vital records (e.g., deaths)	Radio buttons: Y/N
PDMP data can be used for public health surveillance, prevention, and research	Radio buttons: Y/N
PDMP produces regular reports that summarize key state or regional statistics of interest	Radio buttons: Y/N
PDMP produces unsolicited reports	Radio buttons: Y/N If yes, reports are for which groups? (Choose all that apply.) Dropdown list: Prescribers Dispensers Licensing boards Law enforcement agencies Other group(s) (Specify.)________________________________
Interstate agreements to share PDMP data	Radio buttons: Y/N		Section is inserted after Page ID 2.2.3.1
Requirements for prescribers to receive training on safe opioid prescribing	Radio buttons: Y/N
Limit to dose of opioid prescription (e.g., 90 MME/day) without special approval	Radio buttons: Y/N
Limit to the duration of opioid prescription for noncancer patients without special approval	Radio buttons: Y/N
Requirements that pain clinics must be regularly certified by the state medical board	Radio buttons: Y/N N/A (State does not have pain clinics)
Requirements that pain clinics must be owned and operated by a licensed physician	Radio buttons: Y/N N/A (State does not have pain clinics)
Other relevant PDMP guidelines or regulations not captured above?	Free text

>Data Infrastructure

Use this section to enter information regarding data infrastructure and related activities.

Item	Type of Item/Response Options	Technical Notes
During this reporting period, have you engaged in efforts to:
… Enhance access to PDMP data at the grantee/state level?	Radio buttons: Y/N	Section inserted after Page ID 2.2.3.2 in the MRT
… Enhance access to PDMP data at the subrecipient level?	Radio buttons: Y/N
… Enhance usage of PDMP data at the grantee/state level?	Radio buttons: Y/N
… Enhance usage of PDMP data at the subrecipient level?	Radio buttons: Y/N
… Enhance the quality of PDMP data collected?	Radio buttons: Y/N
… Increase registration for the PDMP?	Radio buttons: Y/N
… Increase voluntary PDMP enrollment?	Radio buttons: Y/N
… Increase mandatory PDMP enrollment?	Radio buttons: Y/N
… Increase timely data upload by pharmacists to the PDMP?	Radio buttons: Y/N
… Integrate PDMPs with electronic health records?	Radio buttons: Y/N
… Integrate PDMPs with health information exchanges?	Radio buttons: Y/N
… Increase reports to prescribers?	Radio buttons: Y/N
… Increase reports to dispensers?	Radio buttons: Y/N
… Increase reports to licensing boards?	Radio buttons: Y/N
Please describe any other efforts to improve data infrastructure that have not been captured.	Free text

Training and Technical Assistance

GATHERED IN DSP MRT—NO UNIQUE ITEMS,

Unique Text to add.

Please note that this section does not include prescriber education trainings, which are reported in the Implementation section of this progress report and the Annual Implementation Instrument.

Accomplishments and Barriers/Challenges

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Planning

Strategic Plan

GATHERED IN DSP MRT

ADD PARAGRAPH BELOW AFTER THE 1st PARAGRAPH IN THE DSP MRT INSTRUCTIONS. Please also add to the upload page.

Ensure that your strategic plan clearly explains how PDMP and/or other epidemiological data were used to identify communities with high rates of prescription drug misuse, focuses on improving PDMP partnerships and access/use of PDMP data, identifies data gaps, and addresses program sustainability.

Add after the description of the document item/text box.

Item	Type of Item/ Response Options	Technical Notes
Were PDMP data incorporated into your strategic plan?	Radio buttons: Y/N

Accomplishments and Barriers/Challenges

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Behavioral Health Disparities

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Implementation

Accomplishments and Barriers/Challenges

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Subrecipient Progress

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Promising Approaches and Innovations

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Use of Federal Toolkits/Guidelines

Federal resources have been developed that can assist grantees in training and increasing capacity around the prevention of opioid misuse and overdose. Please describe how the tools noted below were used.

Item	Type of Item/ Response Options	Notes
Did the grantee/state use SAMHSA’s Opioid Overdose Prevention Toolkit?	Radio buttons: Y/N	The items in this table would be inserted after Page ID 2.4.1.1 (Implementation Accomplishments/Barriers).
How was SAMHSA’s Opioid Overdose Prevention Toolkit used?	Free text	This item will only appear if Yes for prior item is selected.
Did the grantee/state use the CDC’s Guidelines for Prescribing Opioids for Chronic Pain?	Radio buttons: Y/N
How were the CDC’s Guidelines for Prescribing Opioids for Chronic Pain used?	Free text	This item will only appear if Yes for prior item is selected.

Community-Based Social Marketing/Public Education Plan

Upload and provide a brief description of your community-based social marketing/public education plan.

Community-Based Social Marketing/Public Education Plan Description

Evaluation

GATHERED IN DSP MRT—NO UNIQUE ITEMS

Sustainability

GATHERED IN DSP MRT—NO UNIQUE ITEMS