A Model for Improving Adherence to Prescribing Guidelines for Chronic Opioid Therapy in Rural Primary Care

Witt, Terrence J.; Deyo-Svendsen, Mark E.; Mason, Elizabeth R.; Deming, James R.; Stygar, Kyja K.; Rosas, Steven L.; Phillips, Michael; Dabrh, Abd Moain Abu

doi:10.1016/j.mayocpiqo.2018.09.004

Cited by 14 publications

(19 citation statements)

References 13 publications

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“…Our results are also echoed in findings from a study of an opioid improvement initiative in another rural setting. Investigators described anecdotal reports of two factors they believe were associated with the observed improvements in opioid medication management: increased communication between patients and providers about risk, and a healthy provider-patient relationship that supported efforts to taper [8]. These are similar to some of the comments made by providers and staff about "patient receptivity" when they discussed changes in how opioids are managed with their patients.…”

Section: Discussionmentioning

confidence: 90%

“…Quality improvement efforts are sensitive to contextual factors that can both inhibit and support these initiatives [7]. However, little is known about how unique attributes of the rural context either pose challenges or facilitate efforts to improve opioid medication management for patients with chronic pain [8]. Also described as "determinants of care or practice," these are factors that enable or hinder the effectiveness of an implementation strategy to improve outcomes [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics

Parchman

Ike

Osterhage

et al. 2020

J. Clin. Trans. Sci.

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Background: Opioids are more commonly prescribed for chronic pain in rural settings in the USA, yet little is known about how the rural context influences efforts to improve opioid medication management. Methods: The Six Building Blocks is an evidence-based program that guides primary care practices in making system-based improvements in managing patients using long-term opioid therapy. It was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period. To gain further insight about their experience with implementing the program, interviews and focus groups were conducted with staff and clinicians at the six organizations at the end of the 15 months and transcribed. Team members used a template analysis approach, a form of qualitative thematic analysis, to code these data for barriers, facilitators, and corresponding subcodes. Results: Facilitators to making systems-based changes in opioid management within a rural practice context included a desire to help patients and their community, external pressures to make changes in opioid management, a desire to reduce workplace stress, external support for the clinic, supportive clinic leadership, and receptivity of patients. Barriers to making changes included competing demands on clinicians and staff, a culture of clinician autonomy, inadequate data systems, and a lack of patient resources in rural areas. Discussion: The barriers and facilitators identified here point to potentially unique determinants of practice that should be considered when addressing opioid prescribing for chronic pain in the rural setting.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics

Parchman

Ike

Osterhage

et al. 2020

J. Clin. Trans. Sci.

View full text Add to dashboard Cite

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“…A similar opioid use review panel was recently described as part of a QI project in Wisconsin. 30 These support mechanisms could include providers from a clinic or groups of clinics, pharmacists, behavioral health clinicians, chronic pain specialists, or others from the local community. In addition, in areas where clinics are more remote, using tele-health modalities such as Project ECHO may help establish peer-to-peer support.…”

Section: Discussionmentioning

confidence: 99%

A New Quality Improvement Toolkit to Improve Opioid Prescribing in Primary Care

et al. 2020

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The role of opioids in managing chronic pain has evolved in light of the opioid misuse epidemic and new evidence regarding risks and benefits of long-term opioid therapy. With mounting national guidelines and local regulations, providers need interventions to standardize and improve safe, responsible prescribing. This article summarizes the evolution of an opioid management toolkit using a quality improvement (QI) approach to improve prescribing. Methods: The authors developed a list of opioid-prescribing best practices and offered in-office, team-based QI projects to ambulatory clinics, updated and tested over 3 trials in the form of a toolkit. Outcome measures included pre-and postproject surveys on provider and staff satisfaction, toolkit completion, and process measures. The toolkit supports workflow planning, redesign, and implementation. Results: Ten clinics participated in trial 1, completing the QI project on average in 3 months, with a mean of 9.1 hours of team time. Provider satisfaction with prescribing increased from 42% to 96% and staff satisfaction from 54% to 81%. The most common strategies in trials 1 and 2 focused on regulatory compliance (35% to 36%), whereas in Trial 3 there was a strong move toward peer support (81%). Discussion: Clinics responded to implementation of opioid-related best practices using QI with improved provider and staff satisfaction. Once the goals of regulatory compliance and workflow improvements were met, clinics focused on strategies supporting providers in the lead role of managing chronic pain, building on strategies that provide peer support. Using QI methods, primary care clinics can improve opioid-prescribing best practices for patients. (

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“…They included 5 physicians in phase 1 and added 18 to phase 2 of the implementation study. They showed a decrease in the number of patients using chronic opioid therapy, primarily at lower doses 12…”

Section: Discussionmentioning

confidence: 99%

“…Although there has been a small decrease in rates of prescribing,9 reports discussing the impact of various interventions have struggled to correlate the development of the new guidelines and the reductions in population-level overdoses 10 11. Nevertheless, interventions, for example audit and feedback, computer decision support systems and multifaceted interventions show more effectiveness for changing prescribing behaviour and may show more effectiveness in reducing opioid prescriptions 12…”

Section: Introductionmentioning

confidence: 99%

Improving opioid guideline adherence: evaluation of a multifaceted, theory-informed pilot intervention for family physicians

et al. 2020

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ObjectivesOpioid-related deaths continue to increase in North America, an epidemic that was initiated by high rates of opioid prescribing. We designed a multifaceted, theory-informed Opioid Self-Assessment (OSA) package, to increase adherence to the Canadian Opioid Guideline among family physicians. This study aimed to assess changes in Canadian family physicians’ knowledge and practices after completing the OSA package.DesignWe conducted a mixed-method evaluation using a pre-test and post-test design that involved the collection of both qualitative and quantitative data.SettingThis research was conducted in the primary care setting in Ontario, Canada.ParticipantsWe recruited a purposive sample of nine family physicians in Ontario who use long-term opioid therapy to treat patients with chronic pain.InterventionsThe OSA package included four components: an online knowledge test, an online learning programme, a safe medication practice self-assessment questionnaire and chart audit with feedback.Outcome measuresOur measures included changes in knowledge, opioid safety practices and physicians’ perspectives on the OSA package.ResultsWe found statistically significant improvements between pre-test and post-test knowledge scores at both baseline and 6-month follow-up. Physicians’ scores improved significantly on five of the seven core characteristics of the practice self-assessment questionnaire. On the chart audits, we observed an improvement in patient education between baseline and 6 months. Qualitative interviews showed that participants appreciated embedded resources in the OSA package. The completion of the package stimulated identification of gaps or deficits in practice and served as a useful reminder to discuss risk and safety with patients. Participants described the chart review as helpful in prompting discussions with their patients, identifying deficits and strengths and a ‘primary motivator’ for project participation.ConclusionsThe OSA package has the potential to improve medication safety practices in primary care related to opioid monitoring and adherence to current opioid guidelines.

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A Model for Improving Adherence to Prescribing Guidelines for Chronic Opioid Therapy in Rural Primary Care

Cited by 14 publications

References 13 publications

Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics

Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics

A New Quality Improvement Toolkit to Improve Opioid Prescribing in Primary Care

Improving opioid guideline adherence: evaluation of a multifaceted, theory-informed pilot intervention for family physicians

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