Examining the effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) at preventing opioid-induced constipation

Taylor Hammack; Clayton J. Hamilton; Amber Martinson

doi:10.5055/jom.0918

Authors

Taylor Hammack, PharmD https://orcid.org/0000-0002-5905-560X
Clayton J. Hamilton, PharmD https://orcid.org/0000-0002-3209-2398
Amber Martinson, PhD https://orcid.org/0000-0002-5329-7616

DOI:

https://doi.org/10.5055/jom.0918

Keywords:

opioid-induced constipation, chronic pain, primary care, veterans

Abstract

Objective: The prevention of opioid-induced constipation (OIC) in patients treated for chronic pain is important for an improved quality of life and prevention of complications. This study aims to determine whether the implementation of the Primary Care Pain Education and Opioid Monitoring Program (PC-POP) improved the management of OIC in patients receiving opioids for chronic noncancer pain.

Design/measure: Pharmacy records regarding the presence of an appropriate laxative prescription, prescription fills, and laxative types were obtained. The primary outcome was the proportion of patients with an appropriate laxative prescription on file for the management of OIC.

Setting: This study was conducted in the Salt Lake City Veterans Affairs (VA) Medical Center’s primary care setting.

Subjects: Patients aged 18 and older being treated with opioids for chronic noncancer pain >3 months who were enrolled in PC-POP and had attended at least two classes were compared to patients receiving standard primary care at a VA Medical Center.

Results: Of the 698 patients included, 39.2 percent of patients enrolled in PC-POP had a laxative prescription on file compared to 20.9 percent for patients receiving standard primary care from a VA provider. Presence of appropriate laxative prescription was significantly higher for the PC-POP group (p = <0.001).

Conclusion: PC-POP enrollment was associated with a significantly higher number of appropriate laxative prescription for the management of OIC. This study indicates that there is potential for improvement in prescribing practices to ensure patients receive appropriate laxatives to mitigate the impact of OIC. It also indicates that implementation of a similar program at other VA Medical Centers could improve OIC management in veterans receiving opioids for chronic noncancer pain.

Author Biographies

Taylor Hammack, PharmD

Providence Willamette Falls Medical Center, Oregon City, Oregon

Clayton J. Hamilton, PharmD

VA Pharmacy Benefits Management Academic Detailing Service, Washington, DC

Amber Martinson, PhD

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

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