Adherence to opioid prescribing guidelines at an academic family medicine practice

Jennifer E. Roper; Brian A. Gottwalt; Julienne K. Kirk; Ann Hiott Barham; Keli B. Jones; John G. Spangler; Michelle K. Keating

doi:10.5055/jom.0931

Authors

Jennifer E. Roper, MD https://orcid.org/0009-0005-6332-0217
Brian A. Gottwalt, DO
Julienne K. Kirk, PharmD https://orcid.org/0000-0002-5144-7780
Ann Hiott Barham, MD
Keli B. Jones, MD
John G. Spangler, MD
Michelle K. Keating, DO MEd

DOI:

https://doi.org/10.5055/jom.0931

Keywords:

analgesics, opioid, family practice, contracts, substance abuse testing

Abstract

Introduction: Opioid prescribing practices and guidelines are outlined by the United States Centers for Disease Control and Prevention (CDC), but limited data are currently available regarding their use in clinical practice. A primary care residency clinical site at an academic medical center attempted to improve compliance with the CDC best practices in 2022. As a quality improvement initiative, a policy was created, and education was provided to clinicians and patients. The clinical impact of these interventions was analyzed.

Methods: A retrospective chart review was performed for patients on chronic opiates during 2023. Extracted electronic health record data were analyzed to collect information on the prescriber (resident/faculty/advanced practice provider), opioid type and duration, concurrent benzodiazepine use, and mental health diagnoses. The main outcomes were whether these patients had an opioid agreement and/or urine drug screen (UDS) in the past 12 months.

Results: A total of 245 patients met the criteria, with 29 percent also being prescribed benzodiazepines, and 69 percent having at least one mental health diagnosis. Forty-one percent of the patients had a UDS in the electronic medical record in 2023, with the statistically significant predictors being nontramadol opioid use and a completed opioid agreement. Thirty-two percent had a completed opioid agreement, with the statistically significant predictors being a concomitant mental health diagnosis, provider type, and UDS obtained.

Discussion/conclusion: Despite policy and education, compliance with our primary outcomes remained low. Residents were the most compliant. Tramadol was also uniquely identified as having lower compliance with having a UDS on file. Next steps include continued education efforts on the risk and best practices for reducing opioid-related harms and structured chart reviews.

Author Biographies

Jennifer E. Roper, MD

Assistant Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina

Brian A. Gottwalt, DO

Physician Fellow, Mountain Area Health Education Center, Asheville, North Carolina

Julienne K. Kirk, PharmD

Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina

Ann Hiott Barham, MD

Associate Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina

Keli B. Jones, MD

Assistant Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina

John G. Spangler, MD

Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina

Michelle K. Keating, DO MEd

Assistant Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina

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