Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleInnovations in Primary Care

The Implementation of a Clinic-Based Opioid Review Board to Address High-Risk Opioid Prescribing in Primary Care

Jonathan L. Robbins, Julie Byler, Angela Vinti, Scott Watson, Afaf Sharen Azar, P. Todd Korthuis and Mary Pickett
The Annals of Family Medicine November 2021, 19 (6) 563; DOI: https://doi.org/10.1370/afm.2738
Jonathan L. Robbins
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: robbijon@ohsu.edu
Julie Byler
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Angela Vinti
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Scott Watson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Afaf Sharen Azar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
P. Todd Korthuis
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mary Pickett
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading
Key words:
  • opioid review board
  • opioid tapering
  • chronic opioid therapy
  • buprenorphine

INNOVATION

The 2016 Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain emphasized safety risks of opioids while promoting a risk-benefit approach to opioid prescribing.1 Although the CDC focused on prescriber decision making around opioid therapy, primary care practices have had little guidance on structural methods that can support safer prescribing.2 We created a clinic-based interprofessional opioid review board (ORB) as a low-barrier, low-cost intervention to improve opioid prescribing safety.

WHO & WHERE

The Internal Medicine clinic at Oregon Health & Science University is a large urban adult primary care practice staffed by 33 faculty physicians and 38 internal medicine residents. We formed an ORB which includes several faculty physicians, a clinical pharmacist, a licensed clinical social worker, a medical assistant, a patient access specialist, and a medical resident. In February 2017, at the inception of the ORB quality intervention, there were 664 patients (5.2% of total practice) on chronic opioid therapy (COT) (Supplemental Appendix, https://www.AnnFamMed.org/lookup/suppl/doi:10.1370/afm.2738/-/DC1).

HOW

Our clinic’s ORB convenes monthly for 1 hour and has several functions: (1) to set clinic policy for safe opioid prescribing aligned with state and federal guidelines and evidence-based practices; (2) to update the patient-clinician opioid agreement; and (3) to conduct formal case reviews of 2 to 4 patients monthly. We will focus on the process of case reviews.

Patients with 6 opioid prescriptions within the most recent 9 months or who have an active opioid agreement make up an electronic registry of patients with COT. From this registry, review board leaders identify cases with high morphine equivalent daily dose (MEDD) or benzodiazepine co-prescribing. We invite the prescribing physician to attend the ORB meeting to provide perspective. The interactions between the ORB and prescribers have remained collegial and constructive.

Two physicians from the committee independently review each case before the ORB meeting. Reviewers make note of pain history, taper attempts, prescription drug–monitoring program data, urine drug screens, visits and cancellation history, opioid-related side effects, alcohol and drug history, active medications, and documentation of functional benefit. A subset of patients have had adverse response to tapering; for these patients, documentation of secondary review supporting the treatment plan is entered in the chart. For patients not in this exceptional group, review findings are summarized in the chart along with specific recommendations to the physician (Supplemental Appendix). A committee follow-up plan is included. Typical recommendations include explicit guidance for opioid or benzodiazepine taper, or to transition to sublingual buprenorphine,3 with or without referral to behavioral health, a clinical pharmacist, or substance use disorder treatment.

LEARNING

The ORB has improved clinic alignment with state and federal guidelines. Collaboration with the prescribing physicians has created a supportive, non-adversarial process in which clinicians do not feel chastised. Increasingly, physicians actively solicit the ORB for assistance in difficult cases, such as high MEDD, aberrant behavior, or concern for substance use disorder. We have observed a consistent decline in high-MEDD prescribing in our practice and increasing use of buprenorphine since implementation of this review board (Supplemental Appendix).

Footnotes

  • Conflicts of interest: authors report none.

  • For supplemental materials, including affiliations, references, and supplemental appendix, go to https://www.AnnFamMed.org/lookup/suppl/doi:10.1370/afm.2738/-/DC1.

  • Received for publication March 18, 2021.
  • Accepted for publication April 13, 2021.
  • © 2021 Annals of Family Medicine, Inc.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 19 (6)
The Annals of Family Medicine: 19 (6)
Vol. 19, Issue 6
1 Nov 2021
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • Plain language article summaries
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Implementation of a Clinic-Based Opioid Review Board to Address High-Risk Opioid Prescribing in Primary Care
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
3 + 11 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
The Implementation of a Clinic-Based Opioid Review Board to Address High-Risk Opioid Prescribing in Primary Care
Jonathan L. Robbins, Julie Byler, Angela Vinti, Scott Watson, Afaf Sharen Azar, P. Todd Korthuis, Mary Pickett
The Annals of Family Medicine Nov 2021, 19 (6) 563; DOI: 10.1370/afm.2738

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
The Implementation of a Clinic-Based Opioid Review Board to Address High-Risk Opioid Prescribing in Primary Care
Jonathan L. Robbins, Julie Byler, Angela Vinti, Scott Watson, Afaf Sharen Azar, P. Todd Korthuis, Mary Pickett
The Annals of Family Medicine Nov 2021, 19 (6) 563; DOI: 10.1370/afm.2738
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • INNOVATION
    • WHO & WHERE
    • HOW
    • LEARNING
    • Footnotes
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Tobacco Cessation Champions: Recognizing Physicians Who Ask, Advise, and Refer
  • Patients Deserve Great Service: The Waiting Room Concierge
  • Facing the Digital Divide: Increasing Video Visits Among Veterans Experiencing Homelessness
Show more INNOVATIONS IN PRIMARY CARE

Similar Articles

Subjects

  • Core values of primary care:
    • Access
    • Coordination / integration of care
  • Other topics:
    • Organizational / practice change

Keywords

  • opioid review board
  • opioid tapering
  • chronic opioid therapy
  • buprenorphine

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine