Multimodal treatment options, including rotating to buprenorphine, within a multidisciplinary pain clinic for patients on risky opioid regimens: A quality improvement study

Benjamin J. Oldfield, Ellen L. Edens, Alicia Agnoli, Curtis W. Bone, Dana J. Cervone, Sara N. Edmond, Ajay Manhapra, John J. Sellinger, William C. Becker

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives. We aimed to evaluate a novel clinical program designed to address unsafe use of opioids prescribed for painthe Opioid Reassessment Clinic (ORC) to inform practice and health system improvement. Design. Controlled, retrospective cohort study. Setting. The ORC is a multidisciplinary clinic in a primary care setting in a Veterans Health Administration hospital designed to perform longitudinal treatment of patients with unsafe use of opioids prescribed for pain, including tapering or rotating to the partial opioid agonist buprenorphine. Subjects. We included patients referred to the ORC from March 1, 2016, to March 1, 2017, who had an intake appointment (intervention group) and who did not (control group). Methods. We compared a priori defined metrics at the patient, clinic process, and health system levels and compared metrics between groups. Results. During the study period, 114 veterans were referred to the ORC, and 71 (62%) of these had an intake appointment. Those in the intervention group were more likely to trial buprenorphine (N=41, 62% vs N=1, 2%, P<0.01) and had greater reductions in their full agonist morphine equivalent daily dose than those in the control group (30mg [interquartile range {IQR} = 0120] vs 0mg [IQR = 020] decrease, P<0.01). Of those engaging in the ORC, 20 (30%) had not transitioned chronic pain management back to their primary care providers (PCPs) by the end of follow-up. Only one patient transitioned the management of buprenorphine to the PCP. Conclusions. Results suggest the ORC was effective in reducing total prescribed opioid doses and in transitioning patients to partial-Agonist therapy, but PCP adoption strategies are needed.

Original languageEnglish (US)
Pages (from-to)S38-S45
JournalPain Medicine (United States)
Volume19
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

Fingerprint

Pain Clinics
Combined Modality Therapy
Buprenorphine
Quality Improvement
Opioid Analgesics
Primary Health Care
Appointments and Schedules
Veterans Health
United States Department of Veterans Affairs
Control Groups
Veterans
Pain Management
Chronic Pain
Morphine
Health Status
Cohort Studies
Retrospective Studies

Keywords

  • Multidisciplinary Treatment Program
  • Opioid Misuse
  • Quality Improvement

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Multimodal treatment options, including rotating to buprenorphine, within a multidisciplinary pain clinic for patients on risky opioid regimens : A quality improvement study. / Oldfield, Benjamin J.; Edens, Ellen L.; Agnoli, Alicia; Bone, Curtis W.; Cervone, Dana J.; Edmond, Sara N.; Manhapra, Ajay; Sellinger, John J.; Becker, William C.

In: Pain Medicine (United States), Vol. 19, 01.09.2018, p. S38-S45.

Research output: Contribution to journalArticle

Oldfield, Benjamin J. ; Edens, Ellen L. ; Agnoli, Alicia ; Bone, Curtis W. ; Cervone, Dana J. ; Edmond, Sara N. ; Manhapra, Ajay ; Sellinger, John J. ; Becker, William C. / Multimodal treatment options, including rotating to buprenorphine, within a multidisciplinary pain clinic for patients on risky opioid regimens : A quality improvement study. In: Pain Medicine (United States). 2018 ; Vol. 19. pp. S38-S45.
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abstract = "Objectives. We aimed to evaluate a novel clinical program designed to address unsafe use of opioids prescribed for painthe Opioid Reassessment Clinic (ORC) to inform practice and health system improvement. Design. Controlled, retrospective cohort study. Setting. The ORC is a multidisciplinary clinic in a primary care setting in a Veterans Health Administration hospital designed to perform longitudinal treatment of patients with unsafe use of opioids prescribed for pain, including tapering or rotating to the partial opioid agonist buprenorphine. Subjects. We included patients referred to the ORC from March 1, 2016, to March 1, 2017, who had an intake appointment (intervention group) and who did not (control group). Methods. We compared a priori defined metrics at the patient, clinic process, and health system levels and compared metrics between groups. Results. During the study period, 114 veterans were referred to the ORC, and 71 (62{\%}) of these had an intake appointment. Those in the intervention group were more likely to trial buprenorphine (N=41, 62{\%} vs N=1, 2{\%}, P<0.01) and had greater reductions in their full agonist morphine equivalent daily dose than those in the control group (30mg [interquartile range {IQR} = 0120] vs 0mg [IQR = 020] decrease, P<0.01). Of those engaging in the ORC, 20 (30{\%}) had not transitioned chronic pain management back to their primary care providers (PCPs) by the end of follow-up. Only one patient transitioned the management of buprenorphine to the PCP. Conclusions. Results suggest the ORC was effective in reducing total prescribed opioid doses and in transitioning patients to partial-Agonist therapy, but PCP adoption strategies are needed.",
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T2 - A quality improvement study

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AU - Edens, Ellen L.

AU - Agnoli, Alicia

AU - Bone, Curtis W.

AU - Cervone, Dana J.

AU - Edmond, Sara N.

AU - Manhapra, Ajay

AU - Sellinger, John J.

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N2 - Objectives. We aimed to evaluate a novel clinical program designed to address unsafe use of opioids prescribed for painthe Opioid Reassessment Clinic (ORC) to inform practice and health system improvement. Design. Controlled, retrospective cohort study. Setting. The ORC is a multidisciplinary clinic in a primary care setting in a Veterans Health Administration hospital designed to perform longitudinal treatment of patients with unsafe use of opioids prescribed for pain, including tapering or rotating to the partial opioid agonist buprenorphine. Subjects. We included patients referred to the ORC from March 1, 2016, to March 1, 2017, who had an intake appointment (intervention group) and who did not (control group). Methods. We compared a priori defined metrics at the patient, clinic process, and health system levels and compared metrics between groups. Results. During the study period, 114 veterans were referred to the ORC, and 71 (62%) of these had an intake appointment. Those in the intervention group were more likely to trial buprenorphine (N=41, 62% vs N=1, 2%, P<0.01) and had greater reductions in their full agonist morphine equivalent daily dose than those in the control group (30mg [interquartile range {IQR} = 0120] vs 0mg [IQR = 020] decrease, P<0.01). Of those engaging in the ORC, 20 (30%) had not transitioned chronic pain management back to their primary care providers (PCPs) by the end of follow-up. Only one patient transitioned the management of buprenorphine to the PCP. Conclusions. Results suggest the ORC was effective in reducing total prescribed opioid doses and in transitioning patients to partial-Agonist therapy, but PCP adoption strategies are needed.

AB - Objectives. We aimed to evaluate a novel clinical program designed to address unsafe use of opioids prescribed for painthe Opioid Reassessment Clinic (ORC) to inform practice and health system improvement. Design. Controlled, retrospective cohort study. Setting. The ORC is a multidisciplinary clinic in a primary care setting in a Veterans Health Administration hospital designed to perform longitudinal treatment of patients with unsafe use of opioids prescribed for pain, including tapering or rotating to the partial opioid agonist buprenorphine. Subjects. We included patients referred to the ORC from March 1, 2016, to March 1, 2017, who had an intake appointment (intervention group) and who did not (control group). Methods. We compared a priori defined metrics at the patient, clinic process, and health system levels and compared metrics between groups. Results. During the study period, 114 veterans were referred to the ORC, and 71 (62%) of these had an intake appointment. Those in the intervention group were more likely to trial buprenorphine (N=41, 62% vs N=1, 2%, P<0.01) and had greater reductions in their full agonist morphine equivalent daily dose than those in the control group (30mg [interquartile range {IQR} = 0120] vs 0mg [IQR = 020] decrease, P<0.01). Of those engaging in the ORC, 20 (30%) had not transitioned chronic pain management back to their primary care providers (PCPs) by the end of follow-up. Only one patient transitioned the management of buprenorphine to the PCP. Conclusions. Results suggest the ORC was effective in reducing total prescribed opioid doses and in transitioning patients to partial-Agonist therapy, but PCP adoption strategies are needed.

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