Development of a standardized approach for managing opioids in adults with chronic noncancer pain

Jessica M. Downes, Donald G Klepser, Jennifer Foster, Maggie Nelson

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The CPP used at a federally qualified health center and primary care clinic was updated in 2015 and included a prescribing ceiling in morphine equivalent dose (MED) per day and standardized the prescribing of chronic opioids. Intermittent urine drug screening performed at least once annually was added as a requirement of the pain management contract between the provider and the patient. An electronic report was developed to identify patients who were receiving long-term opioid therapy at the clinic. The clinical pharmacists identified patients from the report whose long-term opioid doses were over the clinic-recommended MED threshold, needed a pain contract, or were due for a urine drug screen. The number of patients for whom long-term opioids were prescribed decreased for all clinicians, including an 88% reduction by nurse practitioners. Over 12 months, 97 fewer patients with chronic pain were treated with a long-term opioid at the clinic. The number of patients with pain contracts increased by 22.9% (p < 0.001), and the number of patients who had a urine drug screen over a 12-month period increased by 18.3% (p = 0.0016). Conclusion. The implementation of a CPP and the development of electronic reports to track provider adherence to the protocol led to a reduction in the number of chronic pain patients receiving long-term opioid therapy. The number of patients with pain contracts increased.

Original languageEnglish (US)
Pages (from-to)321-326
Number of pages6
JournalAmerican Journal of Health-System Pharmacy
Volume75
Issue number5
DOIs
StatePublished - Mar 1 2018

Fingerprint

Chronic Pain
Opioid Analgesics
Contracts
Urine
Pain
Morphine
Preclinical Drug Evaluations
Nurse Practitioners
Pain Management
Pharmacists
Pharmaceutical Preparations
Primary Health Care
Therapeutics

Keywords

  • Chronic pain
  • FQHC
  • Opioids
  • Pain contract

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

Cite this

Development of a standardized approach for managing opioids in adults with chronic noncancer pain. / Downes, Jessica M.; Klepser, Donald G; Foster, Jennifer; Nelson, Maggie.

In: American Journal of Health-System Pharmacy, Vol. 75, No. 5, 01.03.2018, p. 321-326.

Research output: Contribution to journalArticle

@article{dad2293462ce4a60bdf06d64f7360794,
title = "Development of a standardized approach for managing opioids in adults with chronic noncancer pain",
abstract = "The CPP used at a federally qualified health center and primary care clinic was updated in 2015 and included a prescribing ceiling in morphine equivalent dose (MED) per day and standardized the prescribing of chronic opioids. Intermittent urine drug screening performed at least once annually was added as a requirement of the pain management contract between the provider and the patient. An electronic report was developed to identify patients who were receiving long-term opioid therapy at the clinic. The clinical pharmacists identified patients from the report whose long-term opioid doses were over the clinic-recommended MED threshold, needed a pain contract, or were due for a urine drug screen. The number of patients for whom long-term opioids were prescribed decreased for all clinicians, including an 88{\%} reduction by nurse practitioners. Over 12 months, 97 fewer patients with chronic pain were treated with a long-term opioid at the clinic. The number of patients with pain contracts increased by 22.9{\%} (p < 0.001), and the number of patients who had a urine drug screen over a 12-month period increased by 18.3{\%} (p = 0.0016). Conclusion. The implementation of a CPP and the development of electronic reports to track provider adherence to the protocol led to a reduction in the number of chronic pain patients receiving long-term opioid therapy. The number of patients with pain contracts increased.",
keywords = "Chronic pain, FQHC, Opioids, Pain contract",
author = "Downes, {Jessica M.} and Klepser, {Donald G} and Jennifer Foster and Maggie Nelson",
year = "2018",
month = "3",
day = "1",
doi = "10.2146/ajhp161012",
language = "English (US)",
volume = "75",
pages = "321--326",
journal = "American Journal of Health-System Pharmacy",
issn = "1079-2082",
publisher = "American Society of Health-Systems Pharmacy",
number = "5",

}

TY - JOUR

T1 - Development of a standardized approach for managing opioids in adults with chronic noncancer pain

AU - Downes, Jessica M.

AU - Klepser, Donald G

AU - Foster, Jennifer

AU - Nelson, Maggie

PY - 2018/3/1

Y1 - 2018/3/1

N2 - The CPP used at a federally qualified health center and primary care clinic was updated in 2015 and included a prescribing ceiling in morphine equivalent dose (MED) per day and standardized the prescribing of chronic opioids. Intermittent urine drug screening performed at least once annually was added as a requirement of the pain management contract between the provider and the patient. An electronic report was developed to identify patients who were receiving long-term opioid therapy at the clinic. The clinical pharmacists identified patients from the report whose long-term opioid doses were over the clinic-recommended MED threshold, needed a pain contract, or were due for a urine drug screen. The number of patients for whom long-term opioids were prescribed decreased for all clinicians, including an 88% reduction by nurse practitioners. Over 12 months, 97 fewer patients with chronic pain were treated with a long-term opioid at the clinic. The number of patients with pain contracts increased by 22.9% (p < 0.001), and the number of patients who had a urine drug screen over a 12-month period increased by 18.3% (p = 0.0016). Conclusion. The implementation of a CPP and the development of electronic reports to track provider adherence to the protocol led to a reduction in the number of chronic pain patients receiving long-term opioid therapy. The number of patients with pain contracts increased.

AB - The CPP used at a federally qualified health center and primary care clinic was updated in 2015 and included a prescribing ceiling in morphine equivalent dose (MED) per day and standardized the prescribing of chronic opioids. Intermittent urine drug screening performed at least once annually was added as a requirement of the pain management contract between the provider and the patient. An electronic report was developed to identify patients who were receiving long-term opioid therapy at the clinic. The clinical pharmacists identified patients from the report whose long-term opioid doses were over the clinic-recommended MED threshold, needed a pain contract, or were due for a urine drug screen. The number of patients for whom long-term opioids were prescribed decreased for all clinicians, including an 88% reduction by nurse practitioners. Over 12 months, 97 fewer patients with chronic pain were treated with a long-term opioid at the clinic. The number of patients with pain contracts increased by 22.9% (p < 0.001), and the number of patients who had a urine drug screen over a 12-month period increased by 18.3% (p = 0.0016). Conclusion. The implementation of a CPP and the development of electronic reports to track provider adherence to the protocol led to a reduction in the number of chronic pain patients receiving long-term opioid therapy. The number of patients with pain contracts increased.

KW - Chronic pain

KW - FQHC

KW - Opioids

KW - Pain contract

UR - http://www.scopus.com/inward/record.url?scp=85042404315&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042404315&partnerID=8YFLogxK

U2 - 10.2146/ajhp161012

DO - 10.2146/ajhp161012

M3 - Article

VL - 75

SP - 321

EP - 326

JO - American Journal of Health-System Pharmacy

JF - American Journal of Health-System Pharmacy

SN - 1079-2082

IS - 5

ER -