CP13 - Optimizing Health Center Opioid Prescribing and Monitoring Practices

Poster Type: Research

Primary Funding Source: Health Resources and Services Administration

Category: A. T. Still University

Research Objectives: Opioid use in chronic pain treatment is complex, as patients may derive both benefit and harm from their use. The objective of this project is to help support appropriate clinical decisions related to opioid use in the management of chronic pain and optimize efficacy of the care delivery system.

Study Design/Methods: Providers administer the Screener and Opioid Assessment with Pain-Revised (SOAPP-R) questionnaire to screen patients who are prescribed opioids to categorize the patients into low-risk, moderate-risk and high-risk for opioid dependence. Patients with schedule II, III and IV prescriptions are monitored for aberrant behavior using the Current Opioid Misuse Measure (COMM) questionnaire at their routine visits. Providers also check the Prescription Monitoring Program (PMP) for additional opioid prescriptions from other sources. If aberrant behavior related to medication use is detected, providers are guided to refer the patients to behavioral health, pain management, or wean patients off opioids.

Principal Findings and Quantitative/Qualitative Results: There were more than 2,000 opioid prescriptions written during the ~6 month data collection period. The providers completed 124 SOAPP-R questionnaires of which ~50% were positive, indicating the risk for opioid dependence. 130 COMM questionnaires were completed of which ~20% showed positive results for possible aberrant behavior during their visits. There was an increase in behavioral health referrals for patients with chronic pain on opioids and of the patients referred to pain management, all of them had a positive SOAPP-R, positive COMM, or a positive SOAPP-R and COMM.

Conclusions on Impact on Health Centers: As many as 1 in 4 patients receiving long-term opioid therapy in primary care settings struggle with opioid use disorders. This project has the potential to enhance the care delivery mechanism of the clinic by giving providers standardized and clinically accepted tools to assess patient risk for development of aberrant behaviors when prescribed opioids for pain; aid providers in their ability to recognize aberrant behaviors in patients taking opioids to take note of aberrant behavior; and how to properly implement intervention techniques in patients with aberrant opioid-related behaviors.

Authors:

Ellaheh Ebrahim, MD, Chief Medical Officer and Family Physician, North Central Texas Community Healthcare Center

Ebony Whisenant, MD, Associate Professor, Department of Public Health, Primary Care Transformation Executive Fellowship Program Director, A.T. Still University

Surekha Appikatla, MPH, Data Informatics Specialist, Department of Public Health, A.T. Still University

Debosree Roy, Ph.D., Assistant Professor, Department of Public Health, A.T. Still University

Malissa Ellsworth, MBA, Post-Award Project Manager, Sponsored Programs, A.T. Still University

Joy Lewis, DO, Ph.D., Professor, Medicine and Public Health Chair, Department of Public Health, A.T. Still University