Provider beliefs on the Barriers and Facilitators to Prescription Monitoring Programs and Mandated Use.

Background: Underutilization of Prescription monitoring programs (PMP), especially in states where participation is voluntary could limit their impact against opioid epidemic. Objectives: To (1) examine PMP use among Iowa healthcare providers (HCPs); (2) identify factors prompting and impeding PMP use, and (3) assess beliefs toward mandating PMP use. Methods: A cross-sectional survey of Iowa HCPs was conducted using a 12-item questionnaire. Survey domains include demographics, current PMP utilization, conditions and barriers associated with PMP use, and perspectives on use mandates. Analyses were based on descriptive statistics, proportional odds and poisson regression models. Results: There were 704 usable responses. Almost all respondents were registered with the PMP with dentists having the lowest rate (p < .001). Nurse practitioners consulted the PMP for the largest proportion of prescriptions, while pharmacists and dentists used significantly less (p < .001). Lack of time was the most common reported barrier impeding PMP use. Red flag behaviors and unfamiliarity with patient were the most common conditions prompting PMP review. HCPs estimated their use of the PMP would significantly increase if integrated into their electronic health records (p < .001). Almost half of HCPs held the opinion that PMP use should never be mandated, although inter-provider variation was present with nurse practitioners most amenable to mandates. Discussion: HCPs displayed variation in PMP use. EMR integration appears to be a strategy for increasing PMP use. There was resistance to mandating PMP use for all controlled substances prescribed and dispensed, with some interest in mandates for new patients only or new controlled substance prescriptions only.

Habitat preference of an herbivore shapes the habitat distribution of its host plant.

Plant distributions can be limited by habitat-biased herbivory, but the proximate causes of such biases are rarely known. Distinguishing plant-centric from herbivore-centric mechanisms driving differential herbivory between habitats is difficult without experimental manipulation of both plants and herbivores. Here we tested alternative hypotheses driving habitat-biased herbivory in bittercress (Cardamine cordifolia), which is more abundant under shade of shrubs and trees (shade) than in nearby meadows (sun) where herbivory is intense from the specialist fly Scaptomyza nigrita. This system has served as a textbook example of habitat-biased herbivory driving a plant's distribution across an ecotone, but the proximate mechanisms underlying differential herbivory are still unclear. First, we found that higher S. nigrita herbivory in sun habitats contrasts sharply with their preference to attack plants from shade habitats in laboratory choice experiments. Second, S. nigrita strongly preferred leaves in simulated sun over simulated shade habitats, regardless of plant source habitat. Thus, herbivore preference for brighter, warmer habitats overrides their preference for more palatable shade plants. This promotes the sun-biased herbivore pressure that drives the distribution of bittercress into shade habitats.