Chronic non-terminal pain is common in the United States, and improvements are needed in primary care where most chronic pain is managed. Among the problems associated with chronic pain is the epidemic of prescription opioid misuse and overdose deaths. In 2009, a national panel of experts published consensus guidelines for opioid therapy of chronic pain. Consequently, the Mallinckrodt C.A.R.E.S. AllianceSM has developed a set of tools for clinicians to improve the effectiveness and safety of opioid prescribing that align with the 2009 guidelines. Research to date suggests that many primary care clinicians have not integrated the 2009 guidelines into their work; this Quality Improvement project seeks to address this issue.
The two-phase demonstration project is designed to refine and test implementation of opioid management tools currently used in primary care practice settings, with the broad goal of improving the safety and effectiveness of opioid prescribing for chronic non-terminal pain.
The specific aims are:
Phase 1 (complete) - Expert Panels: We will recruit primary care clinicians, administrative staff and specialist consultants to provide guidance in the refinement of a subset of opioid management tools and in the development of an implementation guide. We will convene each panel twice, for approximately 90 minutes each. Panel outcomes will be a practice-adaptable toolkit and implementation guide.
Phase 2 (recruiting) - Practice Implementation: We are seeking to recruit practices that have identified a need to improve their current opioid prescribing and patient management, but have not yet implemented a process for doing so, or have implemented one but it's not working as planned. Practices that have implemented a successful opioid prescribing and management protocol would not be a good fit for this study. Practice must be willing to implement the management program that is being tested in this project.
We will invite 10 practices to participate in the eight-month implementation phase. During months one and two, practices will continue with usual care, while documenting any concerns and/or frustrations with current opioid management procedures. Patient-reported functional assessment data will be collected during this time to guide subsequent treatment and track opioid prescribing tool implementation. Over the next three months, practices will be asked to utilize the practice-adaptable toolkit and implementation guide with new and current patients. Site visits will be conducted on a subset of practices during this portion of the study. During the final three months, providers and patients will be asked to complete de-identified questionnaires in a traditional practice-based research card study. Practices will also be asked for guidance on improving the tools and implementation guide.
Participation Benefits: Participation Benefits: Expert Panel members will receive $300 for approximately three hours of time reviewing and refining a subset of tools and developing an associated implementation plan. All practices will receive $3,500 for their participation during the eight-month implementation phase.
This project is being conducted from March 1, 2013 through August 2014.
Active intervention is currently in progress.
For additional information about this study, please contact:
Robin Liston, MPH, CHES
Research Project Manager
AAFP National Research Network
Emily Bullard, MPH, CHES
Research Project Coordinator
AAFP National Research Network
This study is just getting started. Check back later for key findings and publications.
This project was supported by a grant from Mallinckrodt C.A.R.E.S. AllianceSM.
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Improving Management of Pain