Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System — United States, 2014–2017

García, Macarena C.; Heilig, Charles M.; Lee, Scott H.; Faul, Margaret M.; Guy, Gery P.; Iademarco, Michael F.; Hempstead, Katherine; Raymond, Dorrie; Gray, Josh

doi:10.15585/mmwr.mm6802a1

Cited by 104 publications

(79 citation statements)

References 8 publications

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“…In contrast, a monotonic urban-rural gradient in percentage of patients receiving at least 1 opioid prescription-with the highest percentage in noncore counties-was reported by Garcia and associates in a national study using primary care opioid prescribing data from an electronic health record vendor. 56 It is unclear precisely what might account for differences in findings across these studies; however, Garcia and associates used patient-weeks rather than population denominators, which would likely affect observed urban-rural opioid prescribing patterns due to urban-rural differences in factors such as access to health care, prevalence of chronic pain and other conditions leading to health care visits, and age distribution (age/sex adjustment was not performed).…”

Section: Discussionmentioning

confidence: 99%

Tracking Opioid Prescribing Metrics in Washington State (2012‐2017): Differences by County‐Level Urban‐Rural and Economic Distress Classifications

Sears

Edmonds

Fulton‐Kehoe

2019

The Journal of Rural Health

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Purpose High‐risk opioid prescribing is a critical driver of prescription opioid‐related morbidity and mortality. This study explored opioid prescribing patterns across urban‐rural and economic distress classifications. Secondarily, this study explored the urban‐rural distribution of relevant health services, economic factors, and population characteristics. Methods County‐level opioid prescribing metrics were based on quarterly Washington State Prescription Monitoring Program data (2012‐2017). Counties were classified using the 2013 National Center for Health Statistics Urban‐Rural Classification Scheme for Counties, and Washington State unemployment‐based distressed areas. County‐level measures from Area Health Resources Files were used to describe the urban‐rural continuum. Findings Persistent economic distress was associated with higher‐risk opioid prescribing. The large central metropolitan category had lower‐risk opioid prescribing metrics than the other 5 urban‐rural categories, which were similar to each other and not ordered by degree of rurality. High‐risk prescribing declined over time, without notable trend divergence by either urban‐rural or economic distress classifications. Conclusions The most striking urban‐rural differences in opioid prescribing metrics were between large central metropolitan and all other categories; thus, we recommend caution when collapsing urban‐rural categories for analysis. Further research is needed regarding geographic and economic patterning of opioid prescribing practices, as well as the dissemination of guidelines and best practices across the urban‐rural continuum. Finally, the multiple intertwined burdens faced by rural communities—higher‐risk prescribing practices, higher opioid morbidity and mortality rates, and fewer resources for primary care, mental health care, alternative pain treatment, and opioid use disorder treatment—must be addressed as an urgent public health priority.

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Section: Discussionmentioning

confidence: 99%

Tracking Opioid Prescribing Metrics in Washington State (2012‐2017): Differences by County‐Level Urban‐Rural and Economic Distress Classifications

Sears

Edmonds

Fulton‐Kehoe

2019

The Journal of Rural Health

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“…For example, major depression may be identified in more than 20% of pain patients in primary care settings, and at even higher rates in pain clinics and orthopedic and rheumatology settings . Acknowledging and addressing the link between pain and behavioral health is a growing national priority, especially with the high rates of opioid use and the increased recognition of the link between psychiatric disorders and opioid misuse …”

Section: Introductionmentioning

confidence: 99%

“…4 Acknowledging and addressing the link between pain and behavioral health is a growing national priority, especially with the high rates of opioid use and the increased recognition of the link between psychiatric disorders and opioid misuse. 5,6 Behavioral therapy is a well-accepted non-medication-based treatment strategy for both pain and common behavioral health conditions such as depression and anxiety. 7 However, fewer than 50% of U.S. adults diagnosed with a mental illness receive treatment at all.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Workplace Outcomes From a Virtually Delivered Cognitive Behavioral Therapy Program for Pain

Mochari‐Greenberger¹,

Andreopoulos²,

Peters³

et al. 2020

Pain Practice

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Objectives To evaluate clinical and workplace outcomes from an evidence‐based virtual behavioral therapy program for individuals with pain and behavioral health issues. Methods This was a retrospective de‐identified data analysis among a cohort of 1,086 participants enrolled in a standardized, evidence‐based telebehavioral therapy program between September 1, 2016, and August 31, 2017 (mean age 53 ± 11.5 years; 29% male). The program was delivered over approximately 8 weeks by licensed therapists and behavior coaches by telephone or video, and tailored to the pain management and behavioral health goals of each participant. Structured measurements were documented in the electronic clinical record, including demographics, comorbidities, pain severity (Pain Intensity, Enjoyment of Life, General Activity tool), behavioral health symptoms (Depression, Anxiety and Stress Scale short form), and productivity (Work Productivity and Activity Impairment survey). Results At baseline, participants had high average pain severity (5.8/10 points), high frequencies of behavioral health symptoms (68%), and activity impairment (90%); absenteeism (34%) and presenteeism (75%) were observed among employed individuals. Pain severity and pain interference improved by 17% and 27%, respectively, over 8 weeks (P < 0.0001). Reductions in depression, anxiety, and stress symptoms were significant and associated with reductions in pain interference (P < 0.0001). Absenteeism, presenteeism, and activity impairment ratings each improved by more than 25% (P < 0.0001). Discussion Participants in a virtually delivered behavioral therapy program for pain experienced significant improvements in pain intensity, pain interference, behavioral health symptoms, and work productivity.

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“…The opioid epidemic has disproportionally affected rural populations in the USA. This may be in part because rates of opioid prescribing are higher [1][2][3] and chronic pain is more prevalent within rural populations [4]. In 2017, 14 of the 15 US counties with the highest rates of opioid prescribing were rural [1].…”

Section: Introductionmentioning

confidence: 99%

“…This may be in part because rates of opioid prescribing are higher [1][2][3] and chronic pain is more prevalent within rural populations [4]. In 2017, 14 of the 15 US counties with the highest rates of opioid prescribing were rural [1]. Providing care to this rural population of patients experiencing chronic pain generally falls on the shoulders of isolated rural primary care providers, who generate many of the opioid prescriptions [5].…”

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.

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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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Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System — United States, 2014–2017

Cited by 104 publications

References 8 publications

Tracking Opioid Prescribing Metrics in Washington State (2012‐2017): Differences by County‐Level Urban‐Rural and Economic Distress Classifications

Tracking Opioid Prescribing Metrics in Washington State (2012‐2017): Differences by County‐Level Urban‐Rural and Economic Distress Classifications

Clinical and Workplace Outcomes From a Virtually Delivered Cognitive Behavioral Therapy Program for Pain

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

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