Article Figures & Data
Figures
- Figure 1
Number of LtOT patients by month.
LtOT = long-term opioid therapy.
- Figure 2
Intervention clinic trend in proportion of patients by MED category.
MED = morphine equivalent dose.
Tables
Characteristic Intervention Group N = 2,065 Control Group N = 1,797 Age, No. (%), y 18-44 384 (18.6) 440 (24.5) 45-64 969 (46.9) 978 (54.4) >64 712 (34.5) 379 (21.1) Sex, No. (%) Male 661 (32.0) 675 (37.6) Female 1,191 (57.7) 1,121 (62.4) Unknown 212 (10.3) Insurance status, %a Medicare 31.8 27.9 Medicaid 22.7 0.59 Private insurance/commercial 32.1 60.5 TRICARE/CHAMPUS 1.8 0 No insurance (self-pay) 7.2 0 Other/unknown 4.3 11.0 CHAMPUS = Civilian Health and Medical Program of the Uniformed Services.
↵a Insurance status reflects that of all patients seen at the study sites, not just those on long-term opioid therapy. Percentages were provided by clinic managers without patient numbers. Insurance status of the control group reflects that of all patients enrolled in the health plan at the time of the study (N = 414,196).
Variable df Coefficient SE t Value P Value Interrupted time series, within study sites Intercept 1 11.929 0.329 36.3 <.0001 Time (secular trend) 1 0.358 0.351 1.02 .320 Change in level 1 −0.054 0.065 −0.82 .420 Change in slope 1 −0.138 0.069 −2.00 .060 Interrupted time series, intervention group vs control group Intercept 1 3.943 0.448 8.8 <.0001 Time (secular trend) 1 −0.226 0.089 −2.55 .019 Change in level 1 1.592 0.478 3.33 .003 Change in slope 1 0.242 0.094 2.58 .018 Variable df Estimate SE t Value P Value Interrupted time series, within study sites Intercept 1 1,680 38.1 44.1 <.0001 Time (secular trend) 1 −133.0 40.7 −3.27 .004 Change in level 1 60.7 7.5 8.04 <.0001 Change in slope 1 −75.8 8.0 −9.48 <.0001
The Article in Brief
Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing
Michael L. Parchman , and colleagues
Background Six key elements to opioid medication management redesign in primary care have been previously identified. This study examines the effect of implementing these "Six Building Blocks" on opioid prescribing practices.
What This Study Found In rural practice, a system redesign resulted in declines in the proportion of patients on high dose opioids and the number of patients receiving opioids. The "Six Building Blocks," a team-based redesign of opioid medication management within smaller practice settings addressing policy changes, patient agreements, patient tracking, in-clinic support, and success metrics, was implemented in 20 clinic locations across eastern Washington and central Idaho. Among patients aged 21 years and over, there was a 2.2% decline in patients receiving high dose opioids over a period of 15 months, compared to a 1.3% decline in the control group. Similarly, a 14% decline was observed in the total number of patients receiving opioids in the intervention clinics compared to a 4.8% control group decline.
Implications
- The results indicate that efforts to redesign care by primary care teams, guided by the Six Building Blocks framework, can improve opioid prescribing practices and possibly reduce dependency.
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