Quality improvement initiative for pain management in primary care
In the context of both chronic pain and opioid crises, this large-system quality improvement project sought to increase use of evidence-based multimodal pain management strategies. Primary care providers (PCPs) in internal medicine and family medicine identified as above- median prescribers of 30-day opioid supplies were selected for intervention. PCPs received individualized email letters showing their opioid prescribing patters relative to peers and urging them to view an internal pain/opioid educational video and related system guidelines. The median number of patients receiving 30-day opioid supplies from our target PCPs decreased over a 24-month period. For cohort patients identified as baseline and remaining in treatment over time, those receiving opioid prescriptions decreased, and those receiving nonopioid prescriptions increased. Percentages of PCPs prescribing nonopioids for cohort patients increased over the first year and nonpharmacologic referrals increased in range. Our evidence suggests that PCPs who are higher opioid prescribers will change their practices voluntarily when given feedback about their opioid prescribing patterns relative to their peers, as well as education regarding evidence-based pain management and opioid prescribing.
Dr. Embry is the E. Rhodes and Leona B. Carpenter Foundation Chair in Family Medicine, co-chair of the Baylor Scott & White Pain Management and Opioid Prescribing Ambulatory Taskforce, and clinical assistant professor at Texas A&M Health Science Center. Dr. Reis is senior vice president and chief medical officer of the Temple Regional Clinics, medical director of family medicine, and co-chair of the Baylor Scott & White Pain Management and Opioid Prescribing Ambulatory Taskforce. Dr. Couchman is senior vice president and chief medical officer, clinical operations, and executive sponsor of the Baylor Scott & White Pain Management and Opioid Prescribing Ambulatory Taskforce. Dr. Ledbetter is senior vice president and chief medical officer of the Dallas–Fort Worth Central Region and vice chairman of the Baylor Scott & White Quality Alliance Board of Managers. Mr. Zolfaghari is a biostatistician for the Center for Applied Health Research, Baylor Scott & White Health. The authors and planner have no conflicts of interest to disclose.
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