Targeted Program Can Improve Adherence to Opioid Prescribing Guidelines

A targeted program that allows all prescribers to access real-time data and track and compare their own performance with those of others can improve adherence to current opioid prescribing guidelines, according to study results published in Arthritis Care & Research.

As part of the efforts to reduce unwarranted opioids prescription, the US Centers for Disease Control and Prevention (CDC) Guidelines for Prescribing Opioids for Chronic Pain for providers recommends a complete risk-benefit assessment before initiating or maintaining opioid therapy.

The Division of Rheumatology at the University of Pennsylvania created a quality improvement program based on electronic health record-integrated data feedback to reduce variability in opioid prescribing and to increase compliance with available guidelines for opioid use for chronic pain. Providers were able to access individualized and division-wide data to assess their performance according to the CDC and local guidelines.

The researchers compared the baseline data from June-August 2017 with monthly data through December 2018.

A signed active opioid agreement was noted for 40% of patients at baseline, and by December 2018, this rate improved to 88%. Urine drug screen within 12 months of receiving an opioid prescription was documented in only 25% of subjects at baseline, and this rate improved to 74% by June 2018 and remained high through December 2018.

The percentage of patients receiving prescriptions for both opioids and benzodiazepines dropped during the study period from 24% at baseline to 20% by June 2018 and to 16% by December 2018.

The mean number of opioid tablets prescribed per month decreased by 18% from 59,733 at baseline to 48,966 by December 2018 (P = .02). The mean number of opioid tablets per prescription per month decreased from 115.4 tablets at baseline to 112.5 by December 2018, but this change was not statistically significant (P = .14).

The study had several limitations, including assessment limited to chronic non-cancer-associated pain, no available data on the number of opioids prescriptions written per provider but only data on the number of tablets per opioid prescription, and missing data on dose changes.

“Overall, this work demonstrates that interdisciplinary goal-setting, provider education, and real-time data feedback can markedly reduce practice variation and increase compliance with national and state-specific guidelines for the prescribing of opioids for the treatment of chronic non-cancer-associated pain,” concluded the researchers.

Reference

Wang EJ, Helgesen R, Johr CR, Lacko HS, Ashburn MA, Merkel PA. A targeted program in an academic rheumatology practice to improve compliance with opioid prescribing guidelines for the treatment of chronic pain [published online Jun 17, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24354