Primary Care Clinic Re-Design for Prescription Opioid Management

Abstract

Background:The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain.Methods: Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations. Site visits included interviews with leadership, clinic tours, observations of clinic processes and team meetings, and interviews with staff and clinicians. Data were reviewed to identify common attributes of clinic system changes around chronic opioid therapy (COT) management. These concepts were reviewed to develop narrative descriptions of key components of changes made to improve COT use.Results: Twenty of the thirty sites had addressed improvements in COT prescribing. Across these sites a common set of 6 Building Blocks were identified: 1) providing leadership support; 2) revising and aligning clinic policies, patient agreements (contracts) and workflows; 3) implementing a registry tracking system; 4) conducting planned, patient-centered visits; 5) identifying resources for complex patients; and 6) measuring progress toward achieving clinic objectives. Common components of clinic policies, patient agreements and data tracked in registries to assess progress are described.Conclusions: In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing COT patients in primary care settings. (J Am Board Fam Med 2017;30:44 -51.)

Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care

“…34–36 Furthermore, the TOPCARE intervention shares characteristics of opioid-prescribing practices among 30 primary care clinics noted nationally for practice innovations 37 : leadership support through clinical champions, revision of prescribing workflows, population management through a registry, planned patient-centered visits (with the nurse care manager), and assessment of progress via data. Nurse care managers play key roles in coordinating the intervention, such as ensuring that monitoring (ie, UDT, pill counts) occurred, interfacing with patients and PCCs to resolve concerning behaviors or pain-relatedneeds, managing the registry (inputting data, printing reports for academic detailing) and directing patients and PCCs to the TOPCARE website (http://mytopcare.org/).…”

Medication‐Assisted Opioid Treatment Prescribers in Federally Qualified Health Centers: Capacity Lags in Rural Areas

“…Future research should also further explore community partnerships and primary care as an effective distribution hub for naloxone, which is an antidote that can reverse opioid overdoses if administered in time . Finally, safe prescribing of opioids is essential to preventing opioid use disorder, and future research should focus on training providers to prescribe responsibly …”

“…51,52 Finally, safe prescribing of opioids is essential to preventing opioid use disorder, and future research should focus on training providers to prescribe responsibly. 53,54 Improving access to treatment for substance use disorders in primary care is a critical part of the strategy to combat the opioid use disorder epidemic. The primary care setting offers a unique opportunity to educate, engage, and motivate patients to initiate and sustain substance use disorder treatment.…”

Practice Innovation for Care Integration, Opioid Management, and Quality Measurement in Family Medicine

“…In an effort to identify common attributes of clinic system changes around managing chronic opioid therapy, Parchman et al 8 conducted site visits at 20 primary care clinics nationwide, which were selected for their use of team-based workforce innovations. A common set of 6 best practices were identified that address complex challenges of managing chronic opioid therapy in primary care settings.…”