PMID- 31285209
OWN - NLM
STAT- MEDLINE
DCOM- 20200511
LR  - 20240214
IS  - 1544-1717 (Electronic)
IS  - 1544-1709 (Print)
IS  - 1544-1709 (Linking)
VI  - 17
IP  - 4
DP  - 2019 Jul
TI  - Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: 
      Effect on Opioid Prescribing.
PG  - 319-325
LID - 10.1370/afm.2390 [doi]
AB  - PURPOSE: Six key elements of opioid medication management redesign in primary 
      care have been previously identified. Here, we examine the effect of implementing 
      these Six Building Blocks on opioid-prescribing practices. METHODS: Six 
      rural-serving organizations with 20 clinic locations received support for 15 
      months during the period October 2015 to May 2017 to implement the Six Building 
      Blocks. Patients undergoing long-term opioid therapy (LtOT) at these study sites 
      were compared with patients undergoing LtOT enrolled in a regional health plan 
      who did not receive care at the study sites but who resided in the same primary 
      care service areas (control group). Outcomes were monthly trend in the proportion 
      of patients undergoing LtOT prescribed a >/=100 morphine equivalent dose (MED) of 
      opioids daily and the total number of patients receiving an opioid prescription. 
      An interrupted time series using difference-indifference analysis was used for 
      tests of significance. RESULTS: The proportion of patients prescribed a >/=100 MED 
      of opioids daily decreased 2.2% (11.8% to 9.6%) among patients at the 
      intervention clinics and 1.3% (14.0% to 12.7%) among patients in the control 
      group. The rate of decrease was significantly greater among study patients than 
      among patients in the control group (P = .018). The rate of decrease in the 
      number of patients on LtOT at intervention clinics increased during the 
      intervention period compared with the preintervention period (P <.001). 
      CONCLUSIONS: Efforts to redesign opioid medication management in primary care 
      resulted in a significant decrease in opioid prescribing. Future research is 
      needed to determine if these results are generalizable to other settings and to 
      assess implications for patient-reported outcomes.
CI  - (c) 2019 Annals of Family Medicine, Inc.
FAU - Parchman, Michael L
AU  - Parchman ML
AD  - Kaiser Permanente Washington Health Research Institute, Seattle, Washington 
      michael.x.parchman@kp.org.
FAU - Penfold, Robert B
AU  - Penfold RB
AD  - Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
FAU - Ike, Brooke
AU  - Ike B
AD  - Department of Family Medicine, University of Washington, Seattle, Washington.
FAU - Tauben, David
AU  - Tauben D
AD  - Department of Medicine, University of Washington, Seattle, Washington.
FAU - Von Korff, Michael
AU  - Von Korff M
AD  - Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
FAU - Stephens, Mark
AU  - Stephens M
AD  - Change Management Consulting, Seattle, Washington.
FAU - Stephens, Kari A
AU  - Stephens KA
AD  - Department of Psychiatry and Behavioral Sciences, University of Washington, 
      Seattle, Washington.
FAU - Baldwin, Laura-Mae
AU  - Baldwin LM
AD  - Department of Family Medicine, University of Washington, Seattle, Washington.
LA  - eng
GR  - R18 HS023750/HS/AHRQ HHS/United States
GR  - UL1 TR002319/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Ann Fam Med
JT  - Annals of family medicine
JID - 101167762
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Analgesics, Opioid/*administration & dosage
MH  - Case-Control Studies
MH  - Chronic Pain/*drug therapy
MH  - Female
MH  - Humans
MH  - Interrupted Time Series Analysis
MH  - Male
MH  - Middle Aged
MH  - Opioid-Related Disorders/prevention & control
MH  - Patient-Centered Care
MH  - *Practice Patterns, Physicians'
MH  - Primary Health Care/*organization & administration
MH  - Quality Improvement
MH  - Rural Population/statistics & numerical data
MH  - Young Adult
PMC - PMC6827656
OTO - NOTNLM
OT  - analgesics
OT  - opioids
OT  - prescriptions
OT  - primary health care
OT  - quality improvement
EDAT- 2019/07/10 06:00
MHDA- 2020/05/12 06:00
PMCR- 2020/01/01
CRDT- 2019/07/10 06:00
PHST- 2018/09/24 00:00 [received]
PHST- 2019/02/22 00:00 [revised]
PHST- 2019/03/13 00:00 [accepted]
PHST- 2019/07/10 06:00 [entrez]
PHST- 2019/07/10 06:00 [pubmed]
PHST- 2020/05/12 06:00 [medline]
PHST- 2020/01/01 00:00 [pmc-release]
AID - 17/4/319 [pii]
AID - 0170319 [pii]
AID - 10.1370/afm.2390 [doi]
PST - ppublish
SO  - Ann Fam Med. 2019 Jul;17(4):319-325. doi: 10.1370/afm.2390.