Geisinger partners with community to reduce opioid addiction
With help from the surrounding community, Geisinger has implemented and expanded its opioid management program to combat opioid use disorder and develop a recovery community for its patients.
“While we have orthopedic protocols for our Musculoskeletal Institute that are in play, they are part of a larger system strategy on opioid crisis management,” Michael Suk, MD, JD, MPH, MBA, FACS, chair of the Geisinger Musculoskeletal Institute and the Department of Orthopaedic Surgery; chief physician officer for Geisinger, told Healio.com/Orthopedics.
Opioid addiction, a community issue
Similar to treatment for behavioral health, Geisinger has implemented the use of peer recovery specialists in their opioid management program. Certified peer recovery specialists are individuals who formerly used opioids or other substances and are currently in recovery. Geisinger employs them professionally in a role that focuses on working with patients in active addiction and getting these patients engaged on a road towards recovery.
“The [certified recovery specialists] CRSs are walking, breathing success stories. ... Using peer recovery specialists in a professional capacity has changed the dynamic of the conversation around treating addiction. They demonstrate that recovery is possible, and are indispensable in developing connections with addicted patients and steering them towards treatment,” Jordan Barbour, MPH, the Geisinger operations director for addiction medicine, told Healio.com/Orthopedics.
In addition to its work with CRS staff, Geisinger has partnered with local opioid coalitions that have brought together law enforcement, leadership at the educational and county level, behavioral health providers, hospitals, health systems and health insurers to have collaborative conversations on opioid addiction as a community issue.
“There’s a lot medicine can do to treat addiction and deal with addiction, but there are limits. So, we think these partnerships are important to address some of those community-based opportunities and developing a recovery community,” Barbour said.
Help from addiction specialists, pharmacists
Geisinger’s four outpatient addiction medicine clinics run by board-certified addiction medicine physicians have also shown favorable outcomes. Over the past 2 years, Geisinger has treated 2,000 patients with an opioid use disorder and has seen an 89% reduction in mortality from opioid use disorder vs. that expected among an untreated population.
Barbour said, in partnership with local pharmacists, Geisinger created a system-wide dashboard that assesses providers’ opioid prescribing trends. The results are thereafter compared with recommendations from the CDC and used to offer a targeted education to providers whose prescribing trends exceed recommended levels.
“Our orthopedic surgeons have a tremendous multidisciplinary relationship with our pharmacists,” Suk said. “To the point, none of the orthopedic surgeons ever feel like they are alone in the pharmacological management of a patient.”
Electronic opioid prescribing
Additionally, Suk reports that implementation of electronic opioid prescriptions has brought about more robust dialogue with patients before and immediately after surgery.
Electronic prescribing of controlled substances has shown significant advantages. Since paper prescriptions are no longer used, there has been a 50% decrease in overall opioid prescribing. The costs savings regarding clinical activity and control are about $1 million.
“We have a robust electronic medical record which acts as the foundation for most of these prescription-based interventions,” Suk said. “Like many places, this is a hard stop, fast, prescription-based electronic medical record intervention.”
In conjunction with the hard stops built into electronic-based prescribing, Geisinger continues to use a multimodal approach to generalize pain management after surgery, which has been successful.
Suk said Geisinger uses selective injections, nerve blocks, acupuncture, meditation, deep breathing and virtual reality to mitigate opioid use.
“This has been a journey we’ve been on for almost a decade as we move towards a less painful orthopedic or musculoskeletal episode, including a focus and attention on opioid management,” Suk said. “The electronic medical process tool has been an important part of our efforts.” – by Monica Jaramillo
Disclosures: Suk and Barbour report no relevant financial disclosures.