J Clin Outcomes Manage
Effect of an opioid management system on opioid prescribing and unscheduled visits in a large primary care clinic
Goldberg KC, Simel DL, Oddone EZ
Abstract Objective: To measure the effect of an explicit pain management program on unscheduled patient visits, prescribing behavior, and opioid use. Design: Retrospective cohort study. Setting: General medicine practice of a university-affiliated Veterans Affairs (VA) hospital. Participants: All patients who had a formal pain management contract and a matched comparison group of patients without evidence of such a contract were evaluated. Intervention: Establishment of a pain management contract, placement of the contract in the medical record, implementation of an opioid prescribing system, and focused attention to pain management by the primary care provider. Measurements: Visits to the emergency department (ED), number of providers of and prescriptions for opioids, consumption of oxycodone, and visits to other VA medical centers. Results: 91 patients with a pain management contract were identified. After implementation, visit frequency to the ED, the number of providers issuing prescriptions, the number of separate prescriptions for opioids, and the number of dispensed oxycodone tablets decreased significantly (p < 0.001 for each measure). Visits to other VA hospitals within the state did not increase. In a matched group of 224 patients receiving opioids, ED visit frequency decreased during the observation period, but to a lesser degree. The number of separate providers issuing opioids to these patients and the number of unique prescriptions did not change over time, although the number of oxycodone tablets consumed increased steadily. Conclusions: A pain management program made explicit by a provider-patient contract can result in fewer unscheduled visits and a consolidation of opioid prescribing toward a single provider.
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