Adherence to Opioid Prescribing Guidelines Improved with Intervention

The multicomponent intervention Transforming Opioid Prescribing in Primary Care was found to improve guideline-concordant care among primary care clinicians prescribing long-term opioids for patients with pain, according to a recent study.

The cluster-randomized study included 53 primary care clinicians and 985 patients who were receiving long-term opioid therapy for pain. Of the patients, 519 were men and 466 were women, and the mean age was 54.7 years. Intervention clinicians received nurse care management, an electronic registry, 1-on-1 academic detailing, and electronic decision tools on safe opioid prescribing. Those assigned to the control group only received electronic decision tools.
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Documentation of guideline-concordant care, determined by both a patient-clinician agreement in the electronic health record and at least 1 urine drug test over 12 months and 2 or more early opioid refills were assessed as the primary outcomes. Opioid dose reduction and opioid discontinuation were assessed as the secondary outcomes.

After 1 year, patients with primary care clinicians assigned to the intervention group were more likely to receive guideline-concordant care compared with those with clinicians in the control group (65.6% vs 37.8%, respectively), and were more likely to undergo at least 1 urine drug test and have a patient-clinician agreement.

Patients with clinicians in the intervention group were more likely to experience a 10% dose reduction or discontinue opioid treatment compared with those in the control group. In addition, those in the intervention group had a mean 6.8 mg lower morphine-equivalent daily dose compared with those in the control group.

However, the odds of an early refill receipt between groups did not differ.

“A multicomponent intervention improved guideline-concordant care but did not decrease early opioid refills,” the researchers concluded.

“While the multicomponent intervention improved adherence to guideline-recommended monitoring of opioids in patients with chronic pain, further research is needed to determine whether guideline adherence reduces opioid-related risks.”

—Melissa Weiss

Reference:

Liebschutz JM, Xuan Z, Shanahan CW, et al. Improving adherence to long-term opioid therapy guidelines to reduce opioid misuse in primary care [published online July 17, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.2468.