‘Building blocks’ model significantly decreases opioid prescriptions
A model that researchers dubbed “Six Building Blocks” led to significant decreases in the proportion of patients on high-dose opioids and the total number of patients receiving opioids in rural clinics, according to findings recently published in Annals of Family Medicine.
“Redesigning how clinics manage opioid medications long-term for patients with chronic pain creates many opportunities for patient-centered conversations between patients and the primary care team about the risks and benefits of continuing the medication or reducing the dose,” Michael L. Parchman, MD, MPH, senior investigator at the MacColl Center for Health Care Innovation Kaiser Permanente Washington Health Research Institute, told Healio Primary Care.
Researchers tested the model, which included building blocks” of — leadership support; revision and alignment of policies and workflows, patient agreements/contracts and clinic policies; a registry tracking system; planned, patient-centered visits; and critical resources for complex patients. The model was implemented approximately between October 2015 and May 2017 in 20 rural clinics in eastern Washington and central Idaho. Opioid prescription rates were compared with those clinicians who used the model (n = 2,065) and those clinicians did not use the model (n = 1,797).
Parchman and colleagues found that the proportion of patients who were prescribed 100 or more morphine equivalent doses of opioids daily dropped from 11.8% to 9.6% among those whose clinicians utilized the model vs. a dosage drop of 14% to 12.7% found among patients whose clinicians did not use the model. The model’s use was also linked to the decreased rate of opioid use (P = .018) and the decreased number of patients on long-term opioid therapy at clinics (P < .001).
Implementing the model presented challenges, according to Parchman.
“Clinics were very frustrated that their electronic health record did not provide an easy way to identify and monitor these patients. No well-defined set of diagnostic or medication codes can be used to search for these patients. Clinics teams were creative in how they overcame this. For example, one clinic was able to identify only those patients who had a patient agreement (some call these ‘pain contracts’) in the medical record to define and monitor this population of patients,” he told Healio Primary Care.
“Clinics were also challenged by their rural location and the long distances to resources for more complex patients such as those who develop opioid use disorder. Several clinics decided to have one or more of their clinicians obtain a waiver to prescribe buprenorphine and offer medication-assisted therapy as a result of implementing the Six Building Blocks,” he said.
Parchman noted that the model provided other benefits besides fewer opioid prescriptions.
“Perhaps the most gratifying aspect of watching primary care teams implement this model was what they told us about how much it decreased their stress and improved the quality of their work life. With such high levels of burnout in primary care, any evidence-based program that both improves patient care and improves quality of work life is seriously worth considering,” he said in the interview.
The Six Building Blocks model can be utilized in urban areas without modification, Parchman added.
Please visit the Healio Opioid Resource Center, which is a collection of news articles and features covering multiple medical specialties provides the latest information on the opioid crisis including treatment strategies, FDA decisions regarding treatments and other important, related announcements.– by Janel Miller
Disclosures: The authors report no relevant financial disclosures.