Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing

Abstract

PURPOSE Six key elements of opioid medication management redesign in primary care have been previously identified. Here, we examine the effect of implementing these Six Building Blocks on opioid-prescribing practices. METHODS Six rural-serving organizations with 20 clinic locations received support for 15 months during the period October 2015 to May 2017 to implement the Six Building Blocks. Patients undergoing long-term opioid therapy (LtOT) at these study sites were compared with patients undergoing LtOT enrolled in a regional health plan who did not receive care at the study sites but who resided in the same primary care service areas (control group). Outcomes were monthly trend in the proportion of patients undergoing LtOT prescribed a ≥100 morphine equivalent dose (MED) of opioids daily and the total number of patients receiving an opioid prescription. An interrupted time series using difference-indifference analysis was used for tests of significance. RESULTS The proportion of patients prescribed a ≥100 MED of opioids daily decreased 2.2% (11.8% to 9.6%) among patients at the intervention clinics and 1.3% (14.0% to 12.7%) among patients in the control group. The rate of decrease was significantly greater among study patients than among patients in the control group (P = .018). The rate of decrease in the number of patients on LtOT at intervention clinics increased during the intervention period compared with the preintervention period (P <.001). CONCLUSIONS Efforts to redesign opioid medication management in primary care resulted in a significant decrease in opioid prescribing. Future research is needed to determine if these results are generalizable to other settings and to assess implications for patient-reported outcomes.

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

“…29,30 At the same time, the call to action to address primary care clinician and staff burnout 31 points to the importance of implementing opioid quality improvement programs that focus not only on patient safety, but also on the work-life conditions of staff and clinicians. The Six Building Blocks program has found that in addition to significant declines in both the proportion of patients on high-dose opioids and the total number of patients receiving opioids in participating clinics, 19 implementing these system-based improvements to opioid medication management also improved clinician and staff perceptions of work-life quality. Future studies should assess the patient perspective specific to clinic redesign programs such as the Six Building Blocks.…”

“…18 A study team from the University of Washington and the MacColl Center for Health Care Innovation at the Kaiser Permanente Washington Health Research Institute tested implementation of the Six Building Blocks through a facilitated program. 19 This program included practice coaching, connection to resources, clinical education, and shared learning with other participating organizations and clinical advisors, described in more detail in Table 1. Following implementation, clinics saw a significant decrease in the number of patients using LtOT and the proportion of patients on high opioid doses.…”

“…Following implementation, clinics saw a significant decrease in the number of patients using LtOT and the proportion of patients on high opioid doses. 19 . The Six Building Blocks Program includes many practical strategies suggested to improve work-life in the primary care setting, such as a focus on team-based care, standardizing workflows, and implementing team visit planning.…”

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

“…Subjects and setting have been previously described [14]. Briefly, six rural-serving primary care organizations with 20 clinic locations in the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region Practice Research Network were enrolled in the study.…”

“…The Six Building Blocks program was subsequently implemented across 20 rural and rural-serving clinics within six organizations. Study outcomes have been previously published [14]. Briefly, the rate of decline in the total number of patients on LtOT increased during the Six Building Blocks' 15 months of practice facilitation support.…”