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Abstract
Background Chronic non-cancer pain (CNCP) affects a significant portion of the United States population each year and is often treated with chronic opioids. Several policies including the 2016 ‘CDC Guidelines for Prescribing Opioids for Chronic Pain’ have been developed to guide CNCP management. These recommendations include the use of pain management agreements, urine drug screening, prescription monitoring programs (PMP), and risk and pain assessments among others. In Texas, several recent policies have made these practices mandatory, requiring support in order to enforce them. Preliminary chart review at UTSW showed low adherence overall.
Objectives Our aim was to improve opioid treatment standards in CNCP patients at UTSW by increasing the number of physicians adhering to Texas Medical Board CNCP treatment requirements to 100% by December 2020.
Methods A three-part intervention including an electronic medical record (EMR) navigator tool (figure 1), chronic opioids registry, and physician education was developed to improve accessibility, documentation, and understanding of opioid prescribing guideline recommendations. A survey was developed to measure physician barriers to policy adherence, attitudes toward the policy components, and current opioid prescribing practices.
Summary of EMR chronic paint navigator tool function and other EMR-integrated tools.
Results Physicians who had used the EMR navigator tool reported overall greater use of several guideline-concordant treatment components compared to those who had not used it (figure 2). Physicians who received opioid prescribing training were more aware and familiar with the policy. Those who had used the EMR navigator tool were more likely to implement pain management agreements and check the PMP (table 1). Only a small percentage of respondents reported co-prescribing naloxone for high-risk CNCP individuals (table 2).
Intervention efficacy, A) Reported awareness of CNCP policy based on training exposure, B) Reported use of guideline treatment components with and without intervention use, ***p<.0001, *p<.05
Summary of survey respondent characteristics pre- and post- intervention with cancer and palliative care respondents removed, SD = standard deviation
Distribution of other chronic pain policy recommendations,% (No.) Measured on a scale from 1-5 where 1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Very Often. MEDD = Morphine Equivalent Daily Dose
Conclusions An EMR navigator tool to improve accessibility of treatment components is effective in improving policy adherence at our institution. These interventions may serve as a valuable tool at other academic medical centers to support safer opioid prescribing and provide a framework for tools to support other guidelines as well.