Factors that impact initiation of pain management agreements for patients on chronic opioid therapy

Katherine Gonzalez; Alejandro Villasante-Tezanos; Gulshan Sharma; Gulshan Doulatram; Stephen B. Williams; Erin L. Hommel

doi:10.5055/jom.0816

Authors

Katherine Gonzalez, BS https://orcid.org/0000-0002-6458-2420
Alejandro Villasante-Tezanos, PhD https://orcid.org/0000-0001-5108-8637
Gulshan Sharma, MD, MPH https://orcid.org/0000-0002-5339-0087
Gulshan Doulatram, MD https://orcid.org/0000-0002-7725-8574
Stephen B. Williams, MD, MS https://orcid.org/0000-0002-2683-2185
Erin L. Hommel, MD https://orcid.org/0000-0003-1975-4008

DOI:

https://doi.org/10.5055/jom.0816

Keywords:

pain management agreement, chronic pain, opioid therapy

Abstract

Objective: This analysis seeks to understand variables within our institution that impact pain management agreement (PMA) utilization for chronic noncancer pain (CNCP).

Design: Retrospective chart review.

Setting: Public academic medical center.

Patients: Adults prescribed an opioid for CNCP between July 2020 and October 2020.

Main outcome measure: We assessed the association between patient demographics, prescription factors, and prescriber factors with the presence of a PMA. Unadjusted rates and chi-square tests were generated for each predictor. Additionally, we performed two multivariable logistic regressions: one including all variables and another utilizing a stepwise forward variable selection process to further understand the relationships between predictors and the presence of a PMA.

Results: 49.7 percent of patients who received an opioid for CNCP had a PMA on file. One significant predictor of the presence of PMA was prescriber specialty with anesthesia/pain medicine, demonstrating 88 percent compliance. Compared to anesthesia/pain medicine, patients receiving opioids from internal medicine had an odds ratio (OR) of 0.155 (95 percent confidence interval (CI), 0.109-0.220), while patients receiving opioids from family medicine had an OR of 0.122 (95 percent CI, 0.090-0.167). Additionally, patients who received schedule II opioids (as opposed to schedule III/IV opioids), patients with multiple opioid fills in 3 months, middle aged patients, and Black patients were more likely to have a PMA.

Conclusions: Compliance with PMA within our institution was only 49 percent despite an existing state law mandating use. Our analysis suggests quality improvement interventions should target patients on schedule III/IV opioids who receive their prescriptions from primary care providers.

Author Biographies

Katherine Gonzalez, BS

School of Medicine, The University of Texas Medical Branch, Galveston, Texas

Alejandro Villasante-Tezanos, PhD

Assistant Professor, Department of Preventative Medicine and Population Health, The University of Texas Medical Branch, Galveston, Texas

Gulshan Sharma, MD, MPH

Professor, Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The University of Texas Medical Branch, Galveston, Texas

Gulshan Doulatram, MD

Professor, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas

Stephen B. Williams, MD, MS

Professor, Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, Texas

Erin L. Hommel, MD

Associate Professor, Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, The University of Texas Medical Branch, Galveston, Texas

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