Group Health establishes major initiative to prevent opioid abuse and overdose
Fatal overdoses involving prescribed opioids tripled in the United States between 1999 and 2006, climbing to almost 14,000 deaths annuallymore than cocaine and heroin overdoses combined. Hospitalizations and emergency room visits related to prescription opioid pain medicines such as oxycodone (brand name Oxycontin) and hydrocodone (Vicodin) also increased dramatically in the same period.
Now a report in the August issue of Health Affairs describes a major initiative at Group Health to make opioid prescribing safer while improving care for patients with chronic pain. Health Affairs is the nation's premier health policy journal, and its August issue focuses on substance abuse.
In the Group Health initiative's first nine months, clinicians at the Seattle-based integrated health system developed and documented care plans for almost 6,000 patients85 percent of those receiving long-term opioid therapy for chronic non-cancer pain.
Group Health's initiative was implemented well before the White House Office of Drug Control Policy, the Food and Drug Administration, and the Drug Enforcement Administration announced a national action plan in April 2011 to stem the epidemic of prescription drug abuse. Scientists from Group Health Research Institute are evaluating the initiative's effects on care, hoping Group Health's experience can help guide national efforts.
Use of prescription opioids has increased sharply since the 1980s. Excluding people with cancer and those in end-of-life care, about 4 percent of U.S. adults now use prescription opioids long term. Pharmaceutical industry advocacy and education have fueled increased opioid prescribing for chronic non-cancer paindespite limited scientific evidence supporting the drugs' long-term effectiveness for chronic non-cancer pain.
In January 2010, Group Health Research Institute Senior Investigator Michael Von Korff, ScD, and colleagues published the first-ever study on overdose risk by dose among patients receiving prescribed opioids for chronic non-cancer pain. That study, published in the Annals of Internal Medicine, linked higher risk of fatal and nonfatal overdose to higher daily dose prescribed. His research also showed that Group Health, like other health systems nationwide, had been prescribing more opioids for chronic non-cancer pain over timea twofold increase from 1997 to 2005.
Group Health launched a major primary care-based initiative to enhance opioid prescribing safety later in 2010. Led by Group Health Medical Director of Primary Care Claire Trescott, MD, the initiative aims to standardize use of opioids for chronic non-cancer pain, without creating undue restrictions on clinically appropriate opioid prescribing.
Using Lean management principles, Dr. Trescott worked with primary care doctors, nurses, pharmacists, pain specialists, and other clinical leaders to formulate new guidelines and related practice changes. These changes include creating standardized care plans for all patients receiving opioids long-term for chronic non-cancer pain.
"Our new opioid care plans specify one responsible prescribing physician, clarify expectations for monitoring and refills, outline treatment goals, and explain risks and side effects of long-term opioid use," said Dr. Trescott.
The individualized plans are created for each patient receiving opioids for 90 days or more. The clinician actively involves patients in the plan development and education on the risks and potential benefits of long-term opioid use. Prescription refill processes are modified to avert problems when patients seek a refill on short notice or run out of medication over a weekend. Periodic monitoring visits with their providers are scheduled, depending on dosage level and risk factors.
Recognizing the importance of provider education, Group Health's Chief of Physical Medicine and Rehabilitation Randi Beck, MD, partnered with Dr. Von Korff to develop an online clinician education course explaining the new guidelines. Funded by a Partnership for Innovation grant from the Group Health Foundation, the course aims to help primary care providers implement recommended practice changes.
By May 2011just 9 months after the new guideline was implementednearly 6,000 care plans were developed with patients receiving opioids for chronic non-cancer pain (85 percent of the target population).
"We see impressive changes when our delivery system, research institute, and foundation collaboratepooling our knowledge, skills, and resources," Dr. Von Korff said. "It's a powerful example of how a learning health care system can act quickly to address important problems in health care."
Provided by Group Health Research Institute
- Higher opioid dose linked to overdose risk in chronic pain patients (w/ Video) Jan 18, 2010 | not rated yet | 0
- Improper use of opioids sparks a new Canadian practice guideline May 03, 2010 | not rated yet | 0
- Risk of death from opioid overdose related to higher prescription dose Apr 05, 2011 | not rated yet | 0
- Doctors lax in monitoring potentially addicting drugs Mar 03, 2011 | not rated yet | 0
- Painkiller prescribing varies dramatically among family physicians: study Mar 14, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
Authorities are investigating rice mills in southern China following tests that found almost half of the staple grain in one of the country's largest cities was contaminated with a toxic metal.
Health 4 minutes ago | not rated yet | 0
The warning images Brussels proposes to include on tobacco packages in order to reduce consumption do not make the desired impact on smokers because they only find some of them really unpleasant. So, if the ...
Health 1 hour ago | not rated yet | 0
Ten years after the Iraq war of 2003 a team of scientists based in Mosul, northern Iraq, have detected high levels of uranium contamination in soil samples at three sites in the province of Nineveh which, coupled with dramatically ...
Health 1 hour ago | not rated yet | 0
When it comes to men's sexual health, dirty jokes may just be the best medicine. A QUT researcher is helping Family Planning Queensland (FPQ) use comedy and YouTube to deliver sexuality education to young ...
Health 2 hours ago | not rated yet | 0
(Medical Xpress)—International researchers are studying the salt intake of Indian adults to provide vital new data to aid the development of a national salt reduction strategy.
Health 2 hours ago | not rated yet | 0
In a remote fishing community in Venezuela, a lone fisherman sits on a cliff overlooking the southern Caribbean Sea. This man –– the lookout –– is responsible for directing his comrades on the water, ...
5 minutes ago | not rated yet | 0 |
Scientists from Nanyang Technological University (NTU) and Lund University, Sweden, have bioengineered a novel molecule which has been proven to successfully kill tumour cells.
14 minutes ago | not rated yet | 0
Regardless of pain, social class or age, a woman is more likely to be prescribed pain-relieving drugs. A study published in Gaceta Sanitaria (Spanish health scientific journal) affirms that this phenomenon is inf ...
24 minutes ago | not rated yet | 0
An article published on the journal Nature describes the major role that Pyruvate dehydrogenase (PDH) —an enzyme of cellular energy metabolism— plays in the regulation of the cellular senescence induce ...
38 minutes ago | not rated yet | 0
Researchers at the University of Illinois at Chicago College of Medicine will study gender differences in how the heart uses and stores fat—its main energy source—and how changes in fat metabolism play ...
54 minutes ago | not rated yet | 0
The negative effects of poorly controlled asthma symptoms on sleep quality and academic performance in urban schoolchildren has been confirmed in a new study.
13 seconds ago | not rated yet | 0