RT Journal Article
SR Electronic
T1 Mayo controlled substance advisory group: A multidisciplinary approach to managing patients on chronic controlled substances
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 2605
DO 10.1370/afm.20.s1.2605
VO 20
IS Supplement 1
A1 Lai, Benjamin
A1 Cunningham, Julie
A1 Crane, Sarah
A1 gazelka, halena
A1 Melin, Gabrielle
A1 Bremseth, Kim
A1 Haag, Jordan
A1 Gilliam, Wesley
A1 Hanson, Lucinda
A1 Stark, Mike
YR 2022
UL http://www.annfammed.org/content/20/Supplement_1/2605.abstract
AB Context: Primary care providers are on the front line of the opioid crisis attempting to appropriately prescribe opioids and provide compassionate care. Providers are in a difficult position and often need the counsel from those in pain management, addiction medicine and medication tapering. This has led to the development of a multidisciplinary Controlled Substance Advisory Group (CSAG) in 2016 at our institution comprising 9 members: 5 from primary care (2 clinicians, 1 pharmacist, 2 nurses); 1 pain specialist; 1 psychiatrist; and 2 pain rehabilitation providers (1 psychologist, 1 pharmacist). Having an outside group review cases and provide recommendations allows providers to preserve their relationship with patients.Objectives: (1) To assess the characteristics of a sample of cases reviewed by CSAG from January 2019 to March 2021 (2) To evaluate the perceived usefulness of the case review process.Study Design: Retrospective review of referred cases. Surveys were sent to referring providers after the review.Setting: Primary care clinics within Mayo Clinic and Mayo Clinic Health Systems in Minnesota.Population: Patients on controlled substances not in hospice and without an active cancer diagnosis. Post-review surveys were sent to referring providers.Intervention: Referring providers are invited to a real-time case review. Recommendations are entered into patients’ health records. Providers are asked to complete an anonymized post-review survey.Outcome measures: Cases reviewed categorized into referral sources, types of controlled substance of concern, and review recommendations; feedback from referring providers.Results: A sample of 72 cases from January 2019 to March 2021 were analyzed: 41% referrals came from physicians, 13% from advanced practice providers, 46% from practice leadership. 94% cases included opioids. Recommendations for 78% of cases included discontinuation/tapering; in the remaining 22%, CSAG recommended starting, restarting, or continuing a controlled substance. CSAG provided recommendations regarding non-controlled adjuncts in 39% of cases. In 32% of cases, CSAG recommended naloxone. 85% referring providers were able to implement most of the recommendations, 79% reported that the review was helpful in preserving provider-patient relationship, 95% would refer cases again and would recommend CSAG to colleagues.Conclusions: CSAG allows providers to have easier access to specialists while preserving relationship with patients.