6 building blocks for safe, team-based opioid prescribing in primary care

By Michael Parchman, MD, MPH, director of the MacColl Center for Health Care Innovation at Group Health Research Institute Forty-four people die every day from prescription opioid overdose. That’s about 16,000 preventable deaths each year—more loss of life than is caused by heroin and cocaine overdoses combined. These statistics are so alarming that the White House has asked the U.S. Department of Health and Human Services to find new ways to battle the opioid abuse and overdose epidemic. The American Academy of Family Physicians has joined that effort, clearly signaling that changing opioid prescribing trends is a priority in primary care. Fortunately, many primary care clinics in the U.S. have made great strides toward safer, more appropriate opioid prescribing for chronic non-cancer pain—also called chronic opioid therapy, or COT. Here in Washington state, for example, Group Health clinics saw a 63 percent decrease in the number of patients on high COT doses thanks to a multi-faceted initiative involving new standard prescribing processes and clinician training. New website guides safer opioid prescribing Through the new Team-Based Opioid Management project, family doctors and other primary care professionals can now learn from, use, and adapt the core principles that Group Health and other clinics have used to change opioid medication management and improve the safety of COT. With support from the Agency for Healthcare Research and Quality, the project’s new public website provides dozens of resources and tools that support safer opioid prescribing, including an online opioid dose calculator that automatically calculates total morphine equivalents per day across a wide range of opioid medications. 6 building blocks derived from real-world primary care The project’s centerpiece is the “Six Building Blocks”—the core components of safe, team-based opioid prescribing that have been implemented successfully in primary care settings across the country.  To develop the six building blocks, project leaders drew from experiences at Group Health and at 31 exemplary primary care practices selected for the LEAP project (Learning from Effective Ambulatory Practices), which aims to improve primary care using a team-based approach. Each building block comes with a comprehensive set of resources designed to help primary care practices achieve high-impact changes like those experienced in LEAP sites and at Group Health. Here is a preview of the six building blocks:
  1. Leadership and consensus: Build organization-wide consensus to prioritize safe, more selective, and more cautious opioid prescribing.
  2. Use a registry to proactively manage patients: Implement pro-active population management before, during, and between clinic visits of all COT patients to ensure that care is safe and appropriate and to measure results of COT improvement activities.
  3. Revise policies and standard work: Revise and implement clinic policies and define standard work for health care team members to achieve safer opioid prescribing and COT management in each clinical contact with COT patients.
  4. Planned, patient-centered visits: Through planned visits, conduct pro-active population management before, during, and between clinic visits of all patients on COT to ensure that care is safe and appropriate. Support patient-centered, empathic communication for COT patient care.
  5. Caring for complex patients: Develop policies and resources to ensure that patients who become addicted to opioids, or who develop complex opioid dependence, are identified and provided with appropriate care, either in the care setting or by outside referral.
  6. Measuring success: Continuously monitor progress and improve with experience.
I hope you’ll visit Team-Based Opioid Management website today and take advantage of the many resources available to help your practice start moving toward safer opioid prescribing.   The Team-Based Opioid Management project is a collaboration among 20 rural and rural-serving primary care clinics in Washington and Idaho (see full list of participating sites). The project is led by Dr. Parchman and a team of researchers and clinicians from Group Health Research Institute’s MacColl Center for Health Care Innovation, the University of Washington Department of Family Medicine’s Research Section, and  the WWAMI region Practice & Research Network (WPRN). Funding for the project comes from the Agency for Healthcare Research and Quality (AHRQ) Grant #R18HS023750.

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