A multicomponent intervention to improve adherence to opioid prescribing and monitoring guidelines in primary care

Kristin T. L. Huang, MD; Deborah Blazey-Martin, MD, MPH; Daniel Chandler, MD; Alysse Wurcel, MD, MS; Joseph Gillis, BA; Julie Tishler, MD

doi:10.5055/jom.2019.0535

Authors

Kristin T. L. Huang, MD
Deborah Blazey-Martin, MD, MPH
Daniel Chandler, MD
Alysse Wurcel, MD, MS
Joseph Gillis, BA
Julie Tishler, MD

DOI:

https://doi.org/10.5055/jom.2019.0535

Keywords:

chronic opioid management, primary care, electronic health record (EHR)

Abstract

Objective: Guidelines for appropriate management of chronic opioid therapy are underutilized by primary care physicians (PCPs). The authors hypothesized that developing a multicomponent, team-based opioid management system with electronic health record (EHR) support would allow our clinicians to improve adherence to chronic opioid prescribing and monitoring guidelines.

Design: This was a retrospective pre-post study.

Setting: The authors performed this intervention at our large, urban, academic primary care practice.

Patients, participants: All patients with the diagnosis of “chronic pain, opioid requiring (ICD-10 F11.20)” on their primary care EHR problem lists were included in this study.

Intervention: The authors implemented a five-pronged strategy to improve our system of opioid prescribing, including (1) a patient registry with regular dissemination of reports to PCPs; (2) standardization of policies regarding opioid prescribing and monitoring; (3) development of a risk-assessment algorithm and risk-stratified monitoring guidelines; (4) a team-based approach to care with physician assistant care managers; and (5) an EHR innovation to facilitate communication and guideline adherence.

Main outcome measures: The authors measured percent adherence to opioid prescribing guidelines, including annual patient-provider agreements, biannual urine drug screens (UDSs), and prescription monitoring program (PMP) verification.

Results: Between September 2015 and September 2016, the percentage of patients on chronic opioid therapy with a signed controlled substances agreement within the preceding year increased from 46 to 76 percent (p < 0.0001), while the percentage of patients with a UDS done within the past 6 months rose from 23 to 79 percent (p < 0.0001). The percentage of patients whose state PMPs profile had been checked by a primary care team member in the past year rose from 45 to 97 percent (p < 0.0001).

Conclusion: A comprehensive strategy to standardize chronic opioid prescribing in our primary care practice coincided with an increase in adherence to opioid management guidelines.

Author Biographies

Kristin T. L. Huang, MD

Assistant Professor of Medicine, Division of Internal Medicine and Adult Primary Care, Tufts Medical Center, Boston, Massachusetts

Deborah Blazey-Martin, MD, MPH

Assistant Professor of Medicine, Division of Internal Medicine and Adult Primary Care, Tufts Medical Center, Boston, Massachusetts

Daniel Chandler, MD

Assistant Professor of Medicine, Division of Internal Medicine and Adult Primary Care, Tufts Medical Center, Boston, Massachusetts

Alysse Wurcel, MD, MS

Assistant Professor of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts

Joseph Gillis, BA

Project Manager, Division of Internal Medicine and Adult Primary Care, Tufts Medical Center, Boston, Massachusetts

Julie Tishler, MD

Assistant Professor of Medicine, Division of Internal Medicine and Adult Primary Care, Tufts Medical Center, Boston, Massachusetts

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