Patient navigation services for chronic opioid therapy were found to decrease opioid dosage as well as the rate of patient discharge from pain management practices, according to results of a prospective, observational study published in Pain Physician.
Patients (N=60) receiving chronic opioid therapy at an independent pain management clinic in the United States were randomly assigned to receive patient navigator services (n=30) or usual care (n=30). The navigator services cohort were contacted weekly, or more often as needed, by a nurse navigator, in addition to participating in monthly visits with a physician. The nurse navigator was trained to act as a health coach and who helped patients identify their health goals and discuss how to overcome barriers. Usual care involved only monthly office visits with a physician. At 90 days, patients in both cohorts were evaluated for pain, opioid consumption, and retention in the practice.
Women made up 63% and 56% of the navigator and control cohorts, respectively. Mean age was 59.4 and 60.6 years, 93% and 87% had spinal pain, initial pain scores were 5.9 and 7.0 on a 10-point scale, mean Opioid Risk Tool (ORT) scores were 0.97 and 1.08, and initial morphine milligram equivalent (MME) dosages were 19.0 and 23.1 per day, respectively.
Compared with the control cohort, the navigator cohort was associated with lower pain scores (mean, 5.9 vs 7.1), opioid dosages (MME, 16.0 vs 28.4 per day), and discharge rates (6.6% vs 23.3%) at 3-month follow-up. Despite outcome differences, participants in both cohorts visited the pain clinic an average of 4 times during the study period.
Among the navigator cohort, predictors for opioid misuse and discharge were symptoms of moderate or severe major depressive disorder and generalized anxiety disorder.
Patients in the intervention cohort provided feedback that their navigator improved their ability to see their provider when they had a problem and helped them organize their schedule.
The major limitations of this study include the small sample size, short follow-up duration, and single-center design.
This study found that patient navigator services helped to decrease opioid consumption and retain patients in a pain management practice compared with usual care for chronic opioid therapy. The study authors report that “[p]atient navigation is a scalable intervention that can be used to decrease the rate of patient noncompliance and improve patient satisfaction.”
Soin A, Barrall D, Chen J, Patel A, Pollack A, Wangombe A. An observational study on the use of a patient navigator to help improve outcomes in patients on chronic opioids. Pain Physician. 2022;25(5):381-386.