Overcoming challenges of prescribing long-term opioid therapy in residency clinics

Kathryn Brown; Joel Farley; Ezra Golberstein; David Satin; Peter Harper; Chrystian Pereira; Andrew H. Slattengren; Kristi Van Riper; Katherine Montag Schafer

doi:10.5055/jom.0869

Authors

Kathryn Brown, MD, MS
Joel Farley, PhD
Ezra Golberstein, PhD
David Satin, MD
Peter Harper, MD, MPH
Chrystian Pereira, PharmD
Andrew H. Slattengren, DO
Kristi Van Riper, MPH
Katherine Montag Schafer, PharmD https://orcid.org/0000-0003-1051-6281

DOI:

https://doi.org/10.5055/jom.0869

Keywords:

opioid, opioid prescribing, chronic pain, residency, family medicine

Abstract

Objectives: To describe the impact of a standardized opioid prescribing intervention when implemented in three family medicine (FM) residency training clinics—environments that face operational challenges including regular resident turnover.

Design: We performed a retrospective cohort study to compare patterns of long-term opioid prescribing between residency and nonresidency clinics.

Setting: This study took place within a large, academic, health system.

Patients and participants: Three FM residency clinics were compared with three nonresidency FM clinics.

Interventions: A standardized opioid prescribing process was developed and implemented within the FM residency clinics. Nonresidency clinics used an independent process and were not exposed to the intervention.

Main outcome measures: Descriptive comparisons were performed for treatment and control clinics' opioid prescribing from 2015 to 2018. The primary outcome was a patient's annual opioid exposure supplied from these select clinics. We also examine coprescribing with high-risk medications that potentiate the overdose risk of opioid prescriptions. Difference-in-difference modeling was used to control for clinic-level variation in practice.

Results: Statistically significant decreases were observed in both residency and nonresidency clinics for the mean number of opioid prescriptions and the mean daily morphine milligram equivalent. These decreases were comparable between the residency and nonresidency clinics.

Conclusions: Residency clinics face unique challenges and require innovative solutions to keep up with best practices in opioid prescribing. Our residency clinics' implementation of a standardized intervention, including electronic health record integration, standardized processes, and metric management, suggests steps that may be valuable in achieving outcomes comparable to nonresidency clinics in large health systems.

Author Biographies

Kathryn Brown, MD, MS

St. John’s Family Medicine Residency Program, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota

Joel Farley, PhD

Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota

Ezra Golberstein, PhD

Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota

David Satin, MD

University of Minnesota Medical Center Residency Program, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota

Peter Harper, MD, MPH

University of Minnesota Medical Center Residency Program, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota

Chrystian Pereira, PharmD

Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota

Andrew H. Slattengren, DO

North Memorial Family Medicine Residency Program, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota

Kristi Van Riper, MPH

Operations Strategy Manager, University of Minnesota Physicians, Minneapolis, Minnesota

Katherine Montag Schafer, PharmD

St. John’s Family Medicine Residency Program, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota

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