MedicalResearch.com Interview with:
Jane M. Liebschutz, MD, MPH
Associate Professor of Medicine
Section of General Internal Medicine
Boston University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: The number of patients receiving opioids for chronic pain has risen over the past 2 decades in the US, in parallel with an increase in opioid use disorder. The CDC and professional medical societies have created clinical guidelines to improve the safety of opioid prescribing, yet individual prescribers can find them onerous to implement.
We developed an intervention to change clinical practice to support primary care physicians who prescribe the majority of opioids for chronic pain. The intervention included 4 elements- a nurse care manager to help assess, educate and monitor patients, an electronic registry to keep track of patient data and produce physician level reports, an individualized educational session for the physician by an opioid prescribing expert based on the physician-specific practice information and online resources to help with decision-making for opioid prescribing (www.mytopcare.org). We tested whether the intervention would improve adherence to guidelines, decrease opioid doses and decrease early refills, as a marker of potential prescription opioid misuse among 985 patients of 53 primary care clinicians in four primary care practices.
MedicalResearch.com: What are the main findings?
Response: The intervention patients were 6 times more likely to receive care adhering to clinical guidelines, and 60% more likely to have a reduction or discontinuation of the opioid dose.
MedicalResearch.com: What should readers take away from your report?
Response: To optimally manage opioid prescribing for chronic pain, primary care practices should consider system changes with the addition of a nurse to work with patients, individual education of providers based on their own practice data, use of a registry to manage populations of patients and accessing available online decision support tools.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We want to know if there are less resource intensive ways to conduct the intervention. We also need to understand the patients’ experience of the intervention, to make sure that patients’ pain does not increase.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Liebschutz JM, Xuan Z, Shanahan CW, LaRochelle M, Keosaian J, Beers D, Guara G, O’Connor K, Alford DP, Parker V, Weiss RD, Samet JH, Crosson J, Cushman PA, Lasser KE. Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care A Cluster-Randomized Clinical Trial. JAMA Intern Med. Published online July 17, 2017. doi:10.1001/jamainternmed.2017.2468
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