The Targeted Care Pathway components included early patient identification, pharmacist enhanced services, patient and professional education, early pain specialist consultation, opioid-sparing multimodal therapies, primary care collaboration, and patient engagement.

The researchers recruited 18 opioid-tolerant participants to receive Pathway Care, and found that the hospital/ER return rate for those receiving Pathway Care was 27.7% compared with 40% for usual care, representing a 30% effect size. The researchers noted that a randomized controlled trial conservatively set for a 20% effect size would need to recruit 564 participants per group.


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The next step is to complete a randomized, controlled trial at Vanderbilt University Medical Center, Massachusetts General Hospital, and Brigham and Women’s Hospital, with the ultimate aim of changing the standard of care for treating opioid-tolerant patients. This new standard of care would include educating practitioners in multimodal pain management strategies to prevent opioid escalation, and helping patients taper off of high-risk medications after surgery.

“The cost of implementing multimodal and multidisciplinary treatment for each opioid tolerant patient will be an important secondary outcome that has implications for broader adoption,” he said. 

Reference

Edwards D, Amstein P, Fitzgerald P, et al. Abstract #172. A Targeted Care Pathway to Improve Outcomes for Opioid-Tolerant Patients: A Pilot Study. Presented at: AAPM 2016. February 18-21, 2016; Palm Springs, California.