Sunday, 17 November 2019
Chronic pain affects an estimated 116 million adults. In the military, chronic pain and opioid therapy is a growing concern. Use of long-term opioid therapy (LOT) in the management of chronic pain without implementing risk mitigation strategies has led to a nationwide epidemic of opioid abuse leading to overdose and death.
The clinical question and purpose is among primary care providers at the family health clinics at Joint Base San Antonio-Lackland and Randolph Air Force Base, does the implementation of a provider-level adherence report affect adherence with the Department of Veterans Affairs (VA) and Department of Defense (DoD) clinical practice guideline (CPG) for management of opioid therapy for chronic pain compared with current practice?
The project design used was a monthly dashboard published to show providers the total number of current LOT orders per provider and individual adherence to risk mitigation strategies outlined in the CPG, focusing on annual urine drug screening (UDS), co-prescription of naloxone, and co-prescription of benzodiazepines. The providers were assigned random numbers, keeping their names anonymous, that were reported in the monthly dashboards. There was a pre-intervention for the 1st quarter of FY2018 that was compared to the 1st quarter of FY2019.
The results were analyzed with each set of variables assessed for normal distribution. Normally distributed results were compared using a paired t-test and non-normally distributed results using a Wilcoxon Signed Rank test. We noted a statistically significant improvement in LOT orders and co-prescription
of naloxone, a decrease in UDS, and no change in co- prescription of benzodiazepines.
Major outcomes impacting organizational and implications for practice include clinically significant increases in naloxone
prescriptions and reduction in opioid prescriptions. Areas for improvement remain in annual urine drug screening compliance. Through a sustainability initiative with Defense Health Agency teams, monthly reports in Care Point are projected to be easily accessible for Pain Champions and
providers to continue with the necessary cultural transformation among opioid prescriptive practices.
The clinical question and purpose is among primary care providers at the family health clinics at Joint Base San Antonio-Lackland and Randolph Air Force Base, does the implementation of a provider-level adherence report affect adherence with the Department of Veterans Affairs (VA) and Department of Defense (DoD) clinical practice guideline (CPG) for management of opioid therapy for chronic pain compared with current practice?
The project design used was a monthly dashboard published to show providers the total number of current LOT orders per provider and individual adherence to risk mitigation strategies outlined in the CPG, focusing on annual urine drug screening (UDS), co-prescription of naloxone, and co-prescription of benzodiazepines. The providers were assigned random numbers, keeping their names anonymous, that were reported in the monthly dashboards. There was a pre-intervention for the 1st quarter of FY2018 that was compared to the 1st quarter of FY2019.
The results were analyzed with each set of variables assessed for normal distribution. Normally distributed results were compared using a paired t-test and non-normally distributed results using a Wilcoxon Signed Rank test. We noted a statistically significant improvement in LOT orders and co-prescription
of naloxone, a decrease in UDS, and no change in co- prescription of benzodiazepines.
Major outcomes impacting organizational and implications for practice include clinically significant increases in naloxone
prescriptions and reduction in opioid prescriptions. Areas for improvement remain in annual urine drug screening compliance. Through a sustainability initiative with Defense Health Agency teams, monthly reports in Care Point are projected to be easily accessible for Pain Champions and
providers to continue with the necessary cultural transformation among opioid prescriptive practices.
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