Dickinson Wright Behavioral Healthcare Practice Group
Peer-Reviewed Article Spotlight: A New Quality Improvement Toolkit to Improve Opioid Prescribing in Primary Care
Journal of the American Board of Family Medicine - The role of opioids in managing chronic pain has evolved in light of the opioid misuse epidemic and new evidence regarding risks and benefits of long-term opioid therapy. With mounting national guidelines and local regulations, providers need interventions to standardize and improve safe, responsible prescribing. This article summarizes the evolution of an opioid management toolkit using a quality improvement (QI) approach to improve prescribing. We've included the list of 28 evidence-based strategies to improve opioid prescribing below - click the button below to read the full text.
Maintain Regulatory Compliance
1. Consider nonopioid alternatives, where possible
2. Provide patient education on benefits and risks, initiate treatment agreement, and obtain informed consent
3. Conduct ongoing risk assessment, such as the Current Opioid Misuse Measure (COMM), and update plan regularly
4. Assess patient function
5. Assess patient pain
6. Check Prescription Drug Monitoring Program
7. Screen urine at least annually for presence/absence of substances (may screen randomly, depending on risk)
8. Use best practices in prescribing: prescribe immediate release opioids, monitor closely any doses of greater than 50 or 90 MME/day, or concurrent dosing of benzodiazepines, and provide naloxone
9. Track dosage in MMEs, not only quantity prescribed
10. Short interval follow up after initiating new opioid treatment to review effect
11. Ongoing visits at least every 3 months
Improve Workflow/Streamline Care
12. Prescribe in multiples of 7 days in duration of dosage (eg, for 28 day, 56 days, … up to 84 days) to support consistent provider/patient relationships
13. Prewrite prescriptions for up to 84 days when management is stable
14. Use a flowsheet to document repeating strategies for opioid management
15. Roster: Include patient in registry for population management reports
Provide Peer-to-Peer Support
16. Use a team-based care approach to opioid treatment
17. Use strategies from the toolkit consistently, so that all patients receive care consistently across the clinic
18. Convene clinic members in a “Pain Management Council” regularly to review and discuss complex patient needs
19. Share skills that are widely useful; eg, how to have “trigger” conversations
20. Build community support with other partners/agencies
Monitor and Respond to Patients who may be at Risk
21. Conduct an initial Risk Assessment
22. Assess side effects (bowel habit, nausea, vomiting…)
23. Recognize special issues presented by patients for therapeutic conversations
24. Prescribe bubble packs if risk level increasing, depending on availability
25. Conduct pill counts or random pill counts
26. Create a tapering schedule with visits based on individual need
27. Identify resources that may be helpful and update periodically
28. Build a patient resource list or offer a library with books, CDs, etc.
SOURCE: Constance van Eeghen, Amanda G. Kennedy, Mark E. Pasanen and Charles D. MacLean. The Journal of the American Board of Family Medicine January 2020, 33 (1) 17-26; DOI: https://doi.org/10.3122/jabfm.2019.01.190238
HEALTH CONTENT DISCLAIMER: The content of this website, such as graphics, images, text and all other materials, is provided for reference and educational purposes only. The content is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. Avant Consulting LLC (AVANT) assumes no duty to correct or update the website nor to resolve or clarify any inconsistent information that might be a part of the website. This website is not an attempt to practice medicine or provide specific medical advice, and it should not be used to make a diagnosis or to replace or overrule a qualified health care provider's judgment. Users should not rely on this website for emergency medical treatment. The content on this website is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always consult with a qualified and licensed physician or other medical care provider, and follow their advice without delay regardless of anything read on this website.
The problems that people will face due to the coronavirus pandemic will go beyond medical issues. Of particular concern are:
Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders
2020 RELEASE - National Academies of Sciences, Engineering, and Medicine
Behavioral health and substance use disorders affect approximately 20 percent of the U.S. population. Of those with a substance use disorder, approximately 60 percent also have a mental health disorder. Together, these disorders account for a substantial burden of disability, have been associated with an increased risk of morbidity and mortality from other chronic illnesses, and can be risk factors for incarceration, homelessness, and death by suicide. In addition, they can compromise a person's ability to seek out and afford health care and adhere to treatment recommendations.
To explore data, policies, practices, and systems that affect the diagnosis and provision of care for mental health and substance use disorders, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine created the Forum on Mental Health and Substance Use Disorders. The forum activities are expected to advance the discussion and generate potential ideas on ways to address many of the most persistent problems in delivering mental health and substance use services. The inaugural workshop, held October 15-16, 2019, in Washington, DC, explored the key policy challenges that impede efforts to improve care for those individuals with mental health and substance use disorders. This publication summarizes the presentations and discussion of the workshop.
SOURCE: National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25690.
LANSING, Michigan. - Governor Gretchen Whitmer signed the “Stay Home, Stay Safe” Executive Order (EO 2020-21), directing all Michigan businesses and operations to temporarily suspend in-person operations that are not necessary to sustain or protect life. The order also directs Michiganders to stay in their homes unless they’re a part of that critical infrastructure workforce, engaged in an outdoor activity, or performing tasks necessary to the health and safety of themselves or their family, like going to the hospital or grocery store.
The U.S. Small Business Administration is offering designated states and territories low-interest federal disaster loans for working capital to small businesses suffering substantial economic injury as a result of the Coronavirus (COVID-19). Upon a request received from a state’s or territory’s Governor, SBA will issue under its own authority, as provided by the Coronavirus Preparedness and Response Supplemental Appropriations Act that was recently signed by the President, an Economic Injury Disaster Loan declaration.
Michigan's Disaster Declaration Details (Disaster #:MI-00081)
SAMHSA RELEASE: Considerations for Outpatient Mental and Substance Use Disorder Treatment Settings