Opioid Monitoring Clinic Improved Practice Guideline Compliance

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After implementation of the OMC, the percentage of PCPs who completed the user survey (n=30) and reported following the VA/DoD clinical practice guidelines increased from 58% at baseline to 90%.
After implementation of the OMC, the percentage of PCPs who completed the user survey (n=30) and reported following the VA/DoD clinical practice guidelines increased from 58% at baseline to 90%.

A nurse practitioner-led opioid monitoring clinic (OMC) implemented at the VA-Las Vegas improved primary care provider compliance with Department of Veterans Affairs (VA)/Department of Defense (DoD) clinical practice guidelines for opioid prescribing and participation with the Nevada Prescription Monitoring Program (PMP). 

Richard Talusan, DNP, FNP-BC, NEA-BC, surveyed all 40 primary care providers (PCPs) at the VA-Las Vegas to determine whether they felt they would benefit from an OMC to assist in identifying opioid abuse, misuse, and diversion. 

In the initial needs assessment, slightly more than half of respondents indicated that they were aware that VA/DoD clinical practice guidelines for opioid prescribing existed, and a similar number indicated that they adhered to the guidelines.

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After implementation of the OMC, the percentage of PCPs who completed the user survey (n=30) and reported following the VA/DoD clinical practice guidelines increased from 58% at baseline to 90%. Furthermore, more than half of survey respondents indicated that they routinely accessed the PMP to check for doctor shopping among patients on opioid therapy after participating in the OMC (54%). 

“By accessing the PMP to screen their patients on opioid therapy, PCPs can help identify and stop abuse and misuse of opioids as early as possible with subsequent referral for treatment as indicated,” said Dr. Talusan.

All PCPs who referred patients to the OMC (n=11) reported overall satisfaction in having the OMC co-manage their patients on chronic opioid therapy.

Overall, 114 patients were seen and evaluated in the OMC from July 1, 2013 to February 18, 2014, and 61 patients agreed to participate in the study (average age 53 years; 4 women, 57 men). 

To be eligible to participate in the study, participants needed to have provider-diagnosed chronic noncancer pain and be prescribed chronic opioid therapy, have a history of substance abuse (ie, heroin, cocaine, alcohol), and/or demonstrate provider-identified and documented aberrant behaviors (ie, report of medication loss, request for early refills).

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