Monitoring long-term opioid therapy and chronic noncancer pain in primary care: Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP)

Amber Martinson, PhD; Patricia Hopkins, PhD; Amanda Kutz, PhD; William R. Marchand, MD; Julie Carney, RN; Katherine Sadler, RN; Jamie Clinton-Lont, MS, CNP

doi:10.5055/jom.2023.0756

Authors

Amber Martinson, PhD
Patricia Hopkins, PhD
Amanda Kutz, PhD
William R. Marchand, MD
Julie Carney, RN
Katherine Sadler, RN
Jamie Clinton-Lont, MS, CNP

DOI:

https://doi.org/10.5055/jom.2023.0756

Keywords:

chronic pain, opioid therapy, primary care, opioid monitoring program

Abstract

Objective: To replicate and extend previous research by examining, among a larger sample, the effectiveness of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) at increasing adherence to the Veteran Affairs/Department of Defense (VA/DoD) recommended guidelines for long-term opioid therapy among chronic noncancer patients seen in primary care—medications, hospitalization, monitoring/safety, assessment, and nonpharmacological pain treatment referrals.

Design/methods: Using data collected from medical records, a between-subjects comparison (PC-POP enrollees vs nonenrollees) was conducted to determine if there were differences between the groups 12 months post-enrollment in PC-POP (12 months post-index date for nonenrollees). Additionally, a within-subjects comparison of outcomes was also conducted with PC-POP enrollees, ie, 12 months pre-enrollment to 12 months post-enrollment.

Subjects: A convenience sample of adult Veterans with chronic noncancer pain receiving opioid therapy consecutively for ≥3 months in primary care.

Results: A total of 734 Veterans (423 PC-POP enrollees and 311 nonenrollees) were included in the analyses. Results showed increased concordance with VA/DoD guidelines among those enrolled in PC-POP, characterized by increased documentation of urine drug screens, Stratification Tool for Opioid Risk Mitigation reports, Narcan education/prescriptions, assessment measures for mental health/substance use/physical function, and referrals for nonpharmacological pain treatment. A decrease in morphine equivalent daily dose among patients enrolled in PC-POP across a 2-year timeframe was also found.

Conclusions: PC-POP increases guideline concordant care for providers working in primary care.

Author Biographies

Amber Martinson, PhD

Department of Psychiatry, VA Salt Lake City Health Care System, University of Utah, Salt Lake City, Utah

Patricia Hopkins, PhD

VA Salt Lake City Health Care System, Salt Lake City, Utah

Amanda Kutz, PhD

Department of Psychiatry, VA Salt Lake City Health Care System, University of Utah, Salt Lake City, Utah

William R. Marchand, MD

Department of Psychiatry, VA Salt Lake City Health Care System, University of Utah, Salt Lake City, Utah

Julie Carney, RN

VA Salt Lake City Health Care System, Salt Lake City, Utah

Katherine Sadler, RN

VA Salt Lake City Health Care System, Salt Lake City, Utah

Jamie Clinton-Lont, MS, CNP

VA Salt Lake City Health Care System, Salt Lake City, Utah

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