Targeting Prescriber Behaviors Trumps Education in Getting Opioid Doses Lower

NATIONAL HARBOR, Md. – Interventions to target prescriber behavior that included weekly updates and formal tapering plans were successful in lowering opioid doses where education alone failed, according to data presented at the 31st Annual Meeting of the American Academy of Pain Medicine. 

The researchers used what they described as “low-burden administrative interventions, or LBAIs, to influence behaviors. 

“LBAIs are those that require little time and money to potentially make a big difference in patient care,” Melissa Stone, PsyD, who led the research team from Boston PainCare, in Waltham, Mass, said in a press release. 

To test whether giving ongoing objective feedback through LBAIs could change prescriber practices, the researchers reviewed chart data for patients 12 weeks before and 12 weeks after the interventions, which included providing prescribers with: 

• A weekly electronic list of patients currently on morphine dose equivalents of ≥200 mg
• Information on whether patients have a formal dose reduction plan 
• Weekly group meetings to review cases of patients on opioids and establish plans to reduce dose in higher dose patients 

Patients actively enrolled in the Medication Management Program at Boston PainCare taking ≥200 mg morphine dose equivalents were reviewed at three time points for daily dose: November 2013 (n=78), February 2014 (n=72) and May 2014 (n=49). 

The outcome was what the investigators hoped to see: No change was observed prior to the interventions; but at 12 weeks after, the percent of patients maintained on ≥200 mg morphine equivalents had dropped to 8% from 13%, and the average daily morphine dose of all patients was 246 mg, down from 280 mg. 

“Through this seemingly small intervention, prescribers received both the support and preparation to properly address dose reductions as part of an overall treatment plan,” said Kelly Wawrzyniak, PsyD, study co-author and member of the research team said in the press release. 

Wawrzyniak described the interdisciplinary approach at Boston PainCare, which combines adjunctive treatments, including injections, physical therapy, mindfulness and behavioral therapy, to help maintain patients on their lowest required opioid dose and allow them to fully function. 

The researchers noted results are forthcoming from a retrospective study showing reduction in opioid doses has in fact led to improved physical functioning, mood and overall well being for many patients. 

Reference

Stone M, et al. “Targeting Prescribers’ Behavior in the Effort to Reduce Patients with Chronic Pain on High-Dose Opioid Therapy: The Impact of Clinician-Focused, Low-Burden Administrative Interventions on Patients’ Opioid Dose.” Poster 197. Presented at: AAPM Annual Meeting. March 19-22, 2015; National Harbor, Maryland.