Article type
Abstract
Background: The US and other countries are experiencing an epidemic of prescription opioid overdoses and deaths as well as adverse effects on morbidity and function. Several organisations have created guidelines for appropriate opioid use. Their ultimate effect on patient and public health will depend on public and provider education, changes in attitudes and demand, beliefs in effectiveness versus harms, reimbursement standards, and successful adherence to guideline recommendations in clinical practice.
Objectives: To describe elements of successful guideline implementation in Marin County CA at a very large group practice, safety net clinics and the county as a whole.
Methods: We reviewed guideline recommendations about use and management of opioids for CNCP and implementation methods used at several group practices. We examined trends in opioid prescribing using internal data and information from a state Prescription Drug Monitoring Program and compared it temporally to use of various implementation techniques.
Results: There were more than 50% reductions in morphine equivalents of opioids prescribed, much fewer high-dose patients, and more modest reductions in prescriptions of other sedative hypnotics. Organisational and leadership support, guideline recommendation content and specificity, training programs, treatment of comorbid psychiatric conditions, provider feedback, use of pharmacist case managers, opioid tapering, and community education to affect demand all appeared to contribute to reductions in inappropriate opioid prescription.
Conclusions: Organisational support, focused training including modeling patient interactions, drug utilisation management, electronic health record prompts, provider feedback and community education are important ways to increase guideline adherence and patient safety. Suggestions for implementation and care management and metrics attached to guidelines increase the possibility that guideline recommendations, patient safety, and quality of care will be improved. Internal development of implementation plans increases buy-in by healthcare providers, enhancing the likelihood of success.
Objectives: To describe elements of successful guideline implementation in Marin County CA at a very large group practice, safety net clinics and the county as a whole.
Methods: We reviewed guideline recommendations about use and management of opioids for CNCP and implementation methods used at several group practices. We examined trends in opioid prescribing using internal data and information from a state Prescription Drug Monitoring Program and compared it temporally to use of various implementation techniques.
Results: There were more than 50% reductions in morphine equivalents of opioids prescribed, much fewer high-dose patients, and more modest reductions in prescriptions of other sedative hypnotics. Organisational and leadership support, guideline recommendation content and specificity, training programs, treatment of comorbid psychiatric conditions, provider feedback, use of pharmacist case managers, opioid tapering, and community education to affect demand all appeared to contribute to reductions in inappropriate opioid prescription.
Conclusions: Organisational support, focused training including modeling patient interactions, drug utilisation management, electronic health record prompts, provider feedback and community education are important ways to increase guideline adherence and patient safety. Suggestions for implementation and care management and metrics attached to guidelines increase the possibility that guideline recommendations, patient safety, and quality of care will be improved. Internal development of implementation plans increases buy-in by healthcare providers, enhancing the likelihood of success.