Context: In the last two decades, opioid abuse has become a major problem in the US. In order to deliver more comprehensive and integrated pain treatment while minimizing opioid misuse, primary care providers (PCP) need to be familiar with best practices on opioid prescribing for chronic noncancer pain (CNCP). Objective: To determine if educating PCPs on safe opioid prescribing increases the level of appropriateness on use of opioid for CNCP. Design: Educational activities including lecture series, electronic health record tools, pocket guides, posters, and regular group emails with updates on the topic were distributed during June through December 2015. A retrospective chart review of adult CNCP patients on opioids for ≥90 days before (08/2014 – 05/2015; pre-intervention) and after PCP education (06/2015-12/2015) was conducted. An opioid appropriateness score was calculated based on documentation of nine items. Categorical variables were analyzed with Chi-square or Fisher exact tests, continuous variables by 2-sample T-tests and regression analysis; binary logistic regression was used for multivariable modeling. Mann-Whitney was used to compare appropriateness scores before and after intervention. Setting: Two academic primary care clinics. Results: Univariate analysis of pre-intervention patients (N=177) demonstrated that younger age, increase morphine equivalent, coexistence of psychiatric conditions, and oxycodone use were associated with increased level of appropriateness. Only younger age remained significant in multivariate analysis (p<0.0001). Univariate analysis of post-intervention patients (N=102) demonstrated that younger age, non-White race, back/neck pain, and clinic location were associated with increased level of appropriateness. Younger age (p=0.0001), back/neck pain (p<0.001), and clinic location (p=0.019) remained significant in multivariate analysis. Post-intervention patients were significantly more likely to have higher median appropriateness scores (6.0 vs. 5.0 among pre-intervention patients; p<0.0001). Both clinics significantly improved appropriateness scores following PCP education (p<0.0001; p=0.0023). Conclusion: Provider education may help to ensure safety, homogeneity, and more appropriate management of CNCP patients.
Kotovicz F, Kram JJ, Flores K, Webster J, McDearmon S, Phelps B, Baumgardner DJ. Impact of primary care provider education on appropriate level of opioid prescription for chronic noncancer pain (CNCP). 2016 North American Primary Care Research Group Annual Meeting Educational Sessions. 2016.