Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Jul;17(4):319-325.
doi: 10.1370/afm.2390.

Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing

Michael L Parchman  1 , Robert B Penfold  2 , Brooke Ike  3 , David Tauben  4 , Michael Von Korff  2 , Mark Stephens  5 , Kari A Stephens  6 , Laura-Mae Baldwin  3
Affiliations
Multicenter Study

Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing

Michael L Parchman et al. Ann Fam Med. 2019 Jul.

Abstract

Purpose: Six key elements of opioid medication management redesign in primary care have been previously identified. Here, we examine the effect of implementing these Six Building Blocks on opioid-prescribing practices.

Methods: Six rural-serving organizations with 20 clinic locations received support for 15 months during the period October 2015 to May 2017 to implement the Six Building Blocks. Patients undergoing long-term opioid therapy (LtOT) at these study sites were compared with patients undergoing LtOT enrolled in a regional health plan who did not receive care at the study sites but who resided in the same primary care service areas (control group). Outcomes were monthly trend in the proportion of patients undergoing LtOT prescribed a ≥100 morphine equivalent dose (MED) of opioids daily and the total number of patients receiving an opioid prescription. An interrupted time series using difference-indifference analysis was used for tests of significance.

Results: The proportion of patients prescribed a ≥100 MED of opioids daily decreased 2.2% (11.8% to 9.6%) among patients at the intervention clinics and 1.3% (14.0% to 12.7%) among patients in the control group. The rate of decrease was significantly greater among study patients than among patients in the control group (P = .018). The rate of decrease in the number of patients on LtOT at intervention clinics increased during the intervention period compared with the preintervention period (P <.001).

Conclusions: Efforts to redesign opioid medication management in primary care resulted in a significant decrease in opioid prescribing. Future research is needed to determine if these results are generalizable to other settings and to assess implications for patient-reported outcomes.

Keywords: analgesics; opioids; prescriptions; primary health care; quality improvement.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Number of LtOT patients by month. LtOT = long-term opioid therapy.
Figure 2
Figure 2
Intervention clinic trend in proportion of patients by MED category. MED = morphine equivalent dose.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Okie S. A flood of opioids, a rising tide of deaths. N Engl J Med. 2010; 363(21): 1981–1985. - PubMed
    1. Guy GP, Jr, Zhang K, Bohm MK, et al. Vital signs: changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017; 66(26): 697–704. - PMC - PubMed
    1. Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying the epidemic of prescription opioid overdose deaths. Am J Public Health. 2018; 108(4): 500–502. - PMC - PubMed
    1. Jones CM. Heroin use and heroin use risk behaviors among non-medical users of prescription opioid pain relievers - United States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013; 132(1-2): 95–100. - PubMed
    1. Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE Randomized Clinical Trial. JAMA. 2018; 319(9): 872–882. - PMC - PubMed

Publication types

Substances