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

Abstract

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. (

Optimising the secondary use of primary care prescribing data to improve quality of care: a qualitative analysis

“…In this study, we set out to investigate sources, secondary uses, and key considerations for optimising primary care prescribing data and its actionability for quality of care related decision-making. Much of the existing literature on measurement for improving primary care prescribing focuses on implementation sciences and practice-level interventions (eg, [44][45][46] ). There is also a dedicated field of research on improving prescribing through interventions in direct patient care (eg, [27][28][29] ).…”

Effects of intervention stage completion in an integrated behavioral health and primary care randomized pragmatic intervention trial

“…Portions of the Toolkit were iteratively developed in previous studies. 16,[21][22][23] In keeping with the pragmatic design of this study, each team tailored its use of the Toolkit according to the needs of the practice, including determining when to start within a 2-year timeframe and which components of the intervention to use.…”

Family Medicine and the “New” Opioid Epidemic

“…Sokol's team 4 used 2 models of change to promote practice improvement for care to both those with OUD and those who are prescribed opioids. Articles by van Eeghen et al 5 ing by state. Jerant et al 8 looked at patient satisfaction related to opioids and found that 6 or more opioid prescriptions per year was associated with higher patient satisfaction.…”