Clinicians in group practice followed state recommendations, and also took part in a multi-faceted risk-reduction initiative implemented by Group Health Cooperative, a state insurance program.
The Group Health program was designed to target safe opioid prescribing and shift practice patterns away from use of high doses. Aspects included a 90-minute online continuing medical education course about chronic pain management and opioids; development of COT care plans in the electronic health record; and an online calculator for estimating MED.
Pharmacy data revealed that the combined initiatives were significantly more effective than the state plan alone for reducing the proportion of COT patients receiving ≥ 120 mg MED from 2006 to June 2014 (16.8% to 6.3% vs 20.6% to 13.6%). The proportion of patients receiving excess opioid days was likewise decreased (24.0% to 10.5% vs 20.1% to 14.7%).
“While dissemination of the statewide guideline may have initiated changes in opioid prescribing among Washington State physicians, more intensive group practice efforts to change shared expectations resulted in greater reductions in high-dose opioid prescribing,” the authors write, attributing the differences to lower rates of dose escalation and increased rates of partial-dose reduction.
Patient outcomes under investigation
According to Dr. Twillman, the unanswered question from this study is, “How does reduced opioid prescribing affect patient outcomes?”
“There are a number of indicators that need to be examined. For instance, was there a reduction in the number of overdoses and overdose deaths as a result of this change? What about other adverse effects? And what were the effects for people with pain — did they demonstrate improved pain control and function, or were there regressions in these measures?” Dr. Twillman explained.
With funding from the Patient-Centered Outcomes Research Institute (PCORI), Dr. Von Korff and colleagues are currently studying the effects of reduced opioid doses on pain outcomes, opioid use disorder, motor vehicle accidents, medically-attended injuries (eg, fractures from falls), and drug overdoses.