Staff and Clinician Work-Life Perceptions after Implementing Systems-Based Improvements to Opioid Management

Abstract

Background: The Six Building Blocks Program is an evidence-based approach to primary care redesign for opioid management among patients with chronic pain. This analysis assesses the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Methods: Six rural and rural-serving primary care organizations with 20 clinic locations implemented the Six Building Blocks with support from a practice facilitator, clinical experts, and an informatics specialist. After 15 months of support, interviews and focus groups were conducted with staff and clinicians in each organization to stimulate reflection on the process and outcomes of implementing the Six Building Blocks Program. Transcripts of interviews and focus groups were coded and analyzed using template analysis. Once a set of themes was agreed on, the primary qualitative analyst revisited the source data to confirm that they accurately reflected the data. Results: Overall, implementing the Six Building Blocks improved provider and staff work-life experience. Reported improvements to work-life included increased confidence and comfort in care provided to patients with long-term opioid therapy, increased collaboration among clinicians and staff, improved ability to respond to external administrative requests, improved relationships with patients using longterm opioid therapy, and an overall decrease in stress. Conclusions: Clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management. Further research is needed on patient experiences specific to practice redesign programs.

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

“…Rural clinic staff and providers emphasized the importance of consistency in opioid prescribing policies across their patient population because of the tight social network within their rural community. They identified this as a strong motivator that facilitated doing this work and described how this consistency improved their work-life and decreased stress [15]. A desire for consistency in care for patients on LtOT was also a motivator identified by McCann and colleagues (2018) in one rural practice when choosing to implement a structured opioid management program [23].…”

“…The rate of decrease in the proportion of patients on higher dose opioids was greater among patients seen in intervention clinics compared to the control group. In addition, clinicians and staff reported improvements in their work-life and decreased levels of stress [15]. Here, we identify and describe barriers and facilitators that influenced implementation of the Six Building Blocks program in these rural and rural-serving primary care organizations from the perspectives of clinicians and staff working in their clinics.…”

Practice-Based Research Today: A Changing Primary Care Landscape Requires Changes in Practice-Based Research Network (PBRN) Research

“…Researchers in Washington applied these same tools of practice facilitation and quality improvement to a vexing problem for primary care physicians, prescribing opioids for chronic pain, and successfully improved clinical work-life for these physicians. 14 Cantone et al 15 used EHR data to study medication assisted treatment uptake for opioid addiction in 2 practices, revealing important predictors to assist further research and clinical care.…”

Training Needs of Practice Facilitators When Implementing An Opioid Improvement Initiative in Primary Care

“…Improving the management of patients with chronic pain who are on long-term opioid therapy (LtOT) is a strategic goal for many health care organizations because of patient safety concerns and the lack of an evidence base for continuing opioids for chronic pain (1,2). The Six Building Blocks (Six BBs) is an evidence-based program to address this important issue in primary care settings (3)(4)(5). Clinics that implement the Six BBs have demonstrated decreases in the number of patients using opioids for chronic pain, decreased rates of high dose opioids among patients using opioid medications for their pain (3), and improved provider and staff con dence and comfort in caring for patients with chronic pain using LtOT (5).…”

“…The Six Building Blocks (Six BBs) is an evidence-based program to address this important issue in primary care settings (3)(4)(5). Clinics that implement the Six BBs have demonstrated decreases in the number of patients using opioids for chronic pain, decreased rates of high dose opioids among patients using opioid medications for their pain (3), and improved provider and staff con dence and comfort in caring for patients with chronic pain using LtOT (5). The program uses a practice facilitation model in which a practice facilitator (PF) external to a clinical organization work with an organization's internal opioid improvement team to implement systems-based changes that support providers and staff in their care of patients with chronic pain.…”