Quality improvement initiative for pain management practices in primary care

Abstract

In the context of both chronic pain and opioid crises, this large-system quality improvement project sought to increase use of evidence-based multimodal pain management strategies. Primary care providers (PCPs) in internal medicine and family medicine identified as above-median prescribers of 30-day opioid supplies were selected for intervention. PCPs received individualized email letters showing their opioid prescribing patterns relative to peers and urging them to view an internal pain/opioid educational video and related system guidelines. The median number of patients receiving 30-day opioid supplies from our target PCPs decreased over a 24-month period. For cohort patients identified at baseline and remaining in treatment over time, those receiving opioid prescriptions decreased, and those receiving nonopioid prescriptions increased. Percentages of PCPs prescribing nonopioids for cohort patients increased over the first year and nonpharmacologic referrals increased in range. Our evidence suggests that PCPs who are higher opioid prescribers will change their practices voluntarily when given feedback about their opioid prescribing patterns relative to their peers, as well as education regarding evidence-based pain management and opioid prescribing.

Keywords: Pain management; chronic pain; clinical practice patterns; evidence-based medicine; instructional films and video; medical education; multimodal treatment.

Figure 1.

Sample audit and feedback showing an individual primary care provider who prescribed 30-day opioid supplies to 61 to 70 patients during a 3-month period.

Figure 2.

Average number of unique patients, per primary care physician, receiving 30-day opioid prescriptions over the duration of the study.

Figure 3.

Percentage of cohort patients receiving 30-day opioid prescriptions, nonopioid prescriptions, and/or pain-related referrals, by calendar quarter.