Abstract
Background/Aims Increased opioid prescribing for chronic non-cancer pain has been accompanied by large increases in prescription opioid abuse and overdose. In April 2011, when the US government initially outlined a plan of action to stem a national epidemic of prescription drug abuse, Group Health (GH) had already implemented a major initiative to increase opioid prescribing safety. Group Health Research Institute had been conducting NIH-funded research on Chronic Opioid Therapy (COT). This research had shown rapid growth in COT prescribing and significant dose-related risks.
Methods Phased implementation of GH’s COT risk mitigation program included: designating a responsible physician for managing COT for each patient; developing care plans; periodic monitoring visits and urine drug screening guidance; standardized treatment agreements; and modifications to refill ordering processes. The guideline was supported by practice alerts, practice tools, performance measures, on-line training, and advocacy from medical staff leaders. Peer experts were trained in each clinic to support implementation. A 90 minute on-line educational program, including 11 clinical scenarios, was completed by primary care staff. In-clinic meetings were held to discuss standardization of COT management.
Results Physician ratings before and after completing the on-line course showed increased confidence in managing chronic pain patients, and more conservative attitudes toward COT prescribing. Within 9 months, care plans were developed for almost 6000 COT patients, 85% of the initially targeted population. Among all COT patients, the percent receiving urine drug screening in a year increased from 7% in the baseline year and 13% in the planning year, to 50% in the initial year of implementation. Among COT patients on higher doses (>120 milligrams morphine equivalent average daily dose), the corresponding percentages receiving urine drug screening were 15%, 21% and 64%. Trends in the percent of adult patients receiving COT and trends in average daily dose of COT patients will also be reported.
Discussion The response of a learning health care system to an emerging prescription drug-abuse crisis exemplifies how integration of public domain research into efforts to improve health care quality and safety can serve patients and the broader public interest.
