Transforming Opioid Prescribing in Primary Care
| Status: | Completed |
|---|---|
| Conditions: | Chronic Pain, Chronic Pain, Gastrointestinal |
| Therapuetic Areas: | Gastroenterology, Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | January 2014 |
| End Date: | March 2016 |
Implementing Opioid Risk Reduction Strategies Into Primary Care Practice
Prescription opioid misuse is a significant public health problem as well as a patient
safety concern. Primary care providers are the leading prescribers of opioids for chronic
pain, yet few providers follow standard practice guidelines regarding assessment and
monitoring. The investigators propose a novel system change in delivery of primary care
services to decrease misuse of and addiction to prescription opioids for patients with
chronic pain.
The proposed intervention for the overall project includes a nurse-managed registry for
planning individual patient care and conducting population-based care for a population of
patients receiving opioids for chronic pain. Academic detailing to clinicians is another
effective way to improve care. Finally, the researchers will create a knowledge management
tool to facilitate guideline adherence. This tool will be accessible via an internet link,
and will include validated instruments to assess patient status and also to facilitate
physician adherence to suggested monitoring.
safety concern. Primary care providers are the leading prescribers of opioids for chronic
pain, yet few providers follow standard practice guidelines regarding assessment and
monitoring. The investigators propose a novel system change in delivery of primary care
services to decrease misuse of and addiction to prescription opioids for patients with
chronic pain.
The proposed intervention for the overall project includes a nurse-managed registry for
planning individual patient care and conducting population-based care for a population of
patients receiving opioids for chronic pain. Academic detailing to clinicians is another
effective way to improve care. Finally, the researchers will create a knowledge management
tool to facilitate guideline adherence. This tool will be accessible via an internet link,
and will include validated instruments to assess patient status and also to facilitate
physician adherence to suggested monitoring.
This project will implement interventions in the primary care setting to improve management
of patients prescribed opioid therapy for chronic non-cancer pain.
Prescription opioid misuse is a significant current public health problem as well as a
patient safety concern. Primary care providers are the leading prescribers of opioids for
chronic pain, yet few providers follow standard practice guidelines regarding assessment and
monitoring. The investigators propose a novel system change in delivery of primary care
services to decrease misuse of and addiction to prescription opioids for patients with
chronic pain.
The researchers will conduct a cluster randomized controlled trial, randomizing 50 primary
care providers and their estimated 500 patients to the intervention condition (nurse care
management, registry, electronic decision support tools, and academic detailing) or control
condition (electronic decision support tools and educational outreach only). The primary
outcomes, measured at twelve months, are PCP adherence to chronic opioid therapy guidelines
and opioid misuse.
of patients prescribed opioid therapy for chronic non-cancer pain.
Prescription opioid misuse is a significant current public health problem as well as a
patient safety concern. Primary care providers are the leading prescribers of opioids for
chronic pain, yet few providers follow standard practice guidelines regarding assessment and
monitoring. The investigators propose a novel system change in delivery of primary care
services to decrease misuse of and addiction to prescription opioids for patients with
chronic pain.
The researchers will conduct a cluster randomized controlled trial, randomizing 50 primary
care providers and their estimated 500 patients to the intervention condition (nurse care
management, registry, electronic decision support tools, and academic detailing) or control
condition (electronic decision support tools and educational outreach only). The primary
outcomes, measured at twelve months, are PCP adherence to chronic opioid therapy guidelines
and opioid misuse.
Inclusion Criteria:
- All PCPs (physicians, doctors of osteopathy, nurse practitioners, and physicians'
assistants) at participating sites with 4 patients prescribed opioid treatment along
with their patients greater than or equal to age 18 who have 1) 3 or more completed
visits to the primary care practice; 2) long-term opioid treatment defined by 3 or
more opioid prescriptions written at least 21 days apart within 6 months; and 3) an
inpatient or outpatient ICD9CM diagnosis for musculoskeletal or neuropathic pain. In
addition, non-PCP staff at the health centers and at the Massachusetts State PMP who
agree to be included in the qualitative assessments will be included and will be
considered subjects. Note that the investigators have limited inclusion in the study
to PCPs with at least 4 patients on chronic opioid therapy because it was determined
that for PCPs with fewer than 4 patients the time burden associated with the study
(meeting with nurse care manager, receiving academic detailing etc) would not be
justified.
Exclusion Criteria:
- Patients currently receiving care for cancer, except non-melanoma skin cancer.
Patients with remote (>5 years) histories being disease-free from other cancers (e.g.
breast, colon, prostate) will not be excluded due to the low risk of current cancer
related pain. PCPs and staff who do not consent to the study.
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