Defining "Doctor Shopping" with Dispensing Data: A Scoping Review

Area of Science:

• Pharmacovigilance
• Health Services Research
• Data Analytics

Background:

• "Doctor shopping" describes patients seeking controlled substances from multiple providers for potential misuse or diversion.
• Accurate identification of this behavior is crucial for public health and drug safety initiatives.

Purpose of the Study:

• To systematically review and analyze the criteria used to detect "doctor shopping" within United States dispensing data.
• To document the evolution and common methodologies employed in identifying this patient behavior.

Main Methods:

• A comprehensive scoping review of peer-reviewed literature from 2000-2020 was conducted.
• Searches focused on studies within the United States, utilizing the Web of Science Core Collection.
• Inclusion criteria required explicit definitions of "doctor shopping" criteria, including prescriber/dispenser counts and drug classes.

Main Results:

• Ninety-five studies met the inclusion criteria, with most published between 2003 and 2020.
• The most prevalent definition involved "≥4 Prescribers AND ≥4 Dispensers" (P x D criteria).
• Opioids were the most frequently studied drug class, followed by benzodiazepines and stimulants. Many studies lacked specific drug ingredient lists.

Conclusions:

• Simple "Prescriber x Dispenser" (P x D) criteria remain the dominant method for identifying "doctor shopping."
• There is a continuous need for the validation of these P x D criteria.
• Emerging analytical methods for dispensing data may necessitate adapting or refining current identification strategies.