In the Journals

Possible 'building blocks' for better opioid prescription management identified

Based on interviews and observations at 30 primary care clinics across the United States, researchers identified six potential ways that could lead to better outcomes in chronic opioid management. The ‘building blocks’ were published in the Journal of the American Board of Family Medicine.

The CDC reported earlier this month that the wave of the opioid epidemic continues to build across the nation, with deaths from opioid abuse increasing in more than half the country.

Researchers from the Robert Wood Johnson Foundation–funded Primary Care Teams: Learning from Exemplar Ambulatory Practices (LEAP) spent 3 days at each site thoroughly observing operations. In their findings, researchers concluded that the building blocks to better chronic opioid therapy (COT) management were:

•    calculating progress toward achieving clinic objectives;
•    pinpointing resources for complex patients;
•    performing planned, patient-centered visits;
•    putting into place a registry tracking system;
•    modifying and aligning workflows, patient agreements/contracts and clinic policies; and
•    providing leadership support.

Researchers reported that 20 of the 30 clinics had taken steps along these lines to improve chronic opioid therapy management.

One of the researchers emphasized the need for primary care doctors to involve everyone on their staffs to implement these calls to action.

“It is important for physicians to not take this on by themselves. Physicians can and should depend on the support of the entire clinic team and on the backing of a clinic-wide consistent approach to providing care to opioid patients,” Michael Parchman, MD, MPH, of the MacColl Center for Health Care Innovation, Seattle, told Healio Family Medicine. “The six building blocks provide a roadmap for this team process. [These are] quite feasible, it stimulates a lot of water cooler conversations across the clinic by everyone, and creates a sense of ‘we are all in this together.’”

Michael Parchman
Michael Parchman

Parchman also offered recommendations on start the process.

“Sit down and discuss the situation with everyone who works in the clinic, and develop a timeline for first reviewing and revising clinic policies and patient agreements. This work proceeds best if led by an administrative partner who can drive the process forward with input from the physician or physicians,” he said. “Once agreed upon and approved, then sit down and examine what clinic workflows need to be re-designed to implement the revised policies and agreements.”

The researchers acknowledged their findings may not be applicable to all locations.

“The themes that emerged consolidate and systemize best practice approaches to addressing the complex challenge of managing COT patients in primary care settings,” Parchman and colleagues wrote. “These findings are not meant to be comprehensive or exclusive of other approaches or strategies that might be equally effective or necessary and clearly must be adapted to local context and resources.”

Citing the “epidemic of overdose deaths”, the CDC issued guidelines for primary care physicians and other medical professionals for opioid prescriptions last year. And over the past month, the FDA has approved several pain relief agents that are specifically manufactured to make them more difficult to abuse. – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.

Based on interviews and observations at 30 primary care clinics across the United States, researchers identified six potential ways that could lead to better outcomes in chronic opioid management. The ‘building blocks’ were published in the Journal of the American Board of Family Medicine.

The CDC reported earlier this month that the wave of the opioid epidemic continues to build across the nation, with deaths from opioid abuse increasing in more than half the country.

Researchers from the Robert Wood Johnson Foundation–funded Primary Care Teams: Learning from Exemplar Ambulatory Practices (LEAP) spent 3 days at each site thoroughly observing operations. In their findings, researchers concluded that the building blocks to better chronic opioid therapy (COT) management were:

•    calculating progress toward achieving clinic objectives;
•    pinpointing resources for complex patients;
•    performing planned, patient-centered visits;
•    putting into place a registry tracking system;
•    modifying and aligning workflows, patient agreements/contracts and clinic policies; and
•    providing leadership support.

Researchers reported that 20 of the 30 clinics had taken steps along these lines to improve chronic opioid therapy management.

One of the researchers emphasized the need for primary care doctors to involve everyone on their staffs to implement these calls to action.

“It is important for physicians to not take this on by themselves. Physicians can and should depend on the support of the entire clinic team and on the backing of a clinic-wide consistent approach to providing care to opioid patients,” Michael Parchman, MD, MPH, of the MacColl Center for Health Care Innovation, Seattle, told Healio Family Medicine. “The six building blocks provide a roadmap for this team process. [These are] quite feasible, it stimulates a lot of water cooler conversations across the clinic by everyone, and creates a sense of ‘we are all in this together.’”

Michael Parchman
Michael Parchman

Parchman also offered recommendations on start the process.

“Sit down and discuss the situation with everyone who works in the clinic, and develop a timeline for first reviewing and revising clinic policies and patient agreements. This work proceeds best if led by an administrative partner who can drive the process forward with input from the physician or physicians,” he said. “Once agreed upon and approved, then sit down and examine what clinic workflows need to be re-designed to implement the revised policies and agreements.”

The researchers acknowledged their findings may not be applicable to all locations.

“The themes that emerged consolidate and systemize best practice approaches to addressing the complex challenge of managing COT patients in primary care settings,” Parchman and colleagues wrote. “These findings are not meant to be comprehensive or exclusive of other approaches or strategies that might be equally effective or necessary and clearly must be adapted to local context and resources.”

Citing the “epidemic of overdose deaths”, the CDC issued guidelines for primary care physicians and other medical professionals for opioid prescriptions last year. And over the past month, the FDA has approved several pain relief agents that are specifically manufactured to make them more difficult to abuse. – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.