Controlled Substance Treatment Agreements in an Internal Medicine Residents' Clinic

Reporting workbench will be used to generate a report from the EMR of all patients of
consenting physicians prescribed a controlled substance, carisoprodol, or tramadol at least
3 times in the past 6 months. This report will also include demographics, number of ED
visits in the last 6 months, hospital admissions in the last 6 months, the number of
telephone calls documented in the last 6 months, the number of clinic visits in the last 6
months, the number of missed clinic visits in the last 6 months, controlled substance
prescribed, directions for use, number of tabs of medication prescribed, number of refills
given, order date and date of completion of urine drug screen if in last 6 months, if
chronic pain is listed as a medical problem, and if controlled substance treatment agreement
has been signed and scanned into EMR. For each patient of the consenting physicians, the EMR
will be reviewed to track next clinic visit date, urine toxicology screen results, and if
there is documentation of an Ohio Automated Rx Reporting System (OARRS) review. The MED for
each patient will be obtained from the OARRS report and included on the data collection
form. For any patients taking opioid substances at MED ≥ 80 mg/day a review of the
appropriateness of this medication and dose based on EMR documentation will be conducted by
clinic physicians and/or pharmacists. This will all be done in order to make recommendations
to the resident physician based on our best practice recommended controlled substance
agreement.

For all patients of the consenting physicians who have an upcoming office visit scheduled,
any recommendations for improved adherence to the CSTA or change in controlled substance,
carisoprodol, or tramadol prescribing based on EMR review findings will be given to the
patient's physician prior to the office visit. Because this intervention is a quality
improvement intervention and studies physician decision making but no direct interaction
with the patient, the patient will not know this study is occurring. An EMR review after the
patient's visit will be completed to track the acceptance of these recommendations leading
to changes in the parameters listed in the data analysis section. Additionally, a second
report will be generated from the reporting workbence 6 months after implementation of this
workflow which includes all patients of the consenting physicians prescribed controlled
substances, tramadol, and carisoprodol (including those on the initial report and those who
are now new patients controlled substances since the time the report was generated) to
characterize the improvement in these parameters for patients in clinic as a whole to track
the improvement in adherence to a controlled substance treatment agreement. See study
procedures in Figure 1. Data Collection will start on 8/1/14 and continue until 12/31/15.

Inclusion Criteria:

- Age 18 years and older

- Residents and attending physicians who work in the resident continuity practice

Exclusion Criteria:

- Age < 18 years of age