RESUMEN
In response to the opioid epidemic, the Centers for Disease Control and Prevention released best practice recommendations for prescribing, yet adoption of these guidelines has been fragmented and frequently met with uncertainty by both patients and providers. This study aims to describe the development and implementation of a comprehensive approach to improving opioid stewardship in a large network of primary care providers. The authors developed a 3-tier approach to opioid management: (1) establishment and implementation of best practices for prescribing opioids, (2) development of a weaning process to decrease opioid doses when the risk outweighs benefits, and (3) support for patients when opioid use disorders were identified. Across 44 primary care practices caring for >223,000 patients, the total number of patients prescribed a chronic opioid decreased from 4848 patients in 2018 to 3106 patients in 2021, a decrease of 36% (P < 0.001). The percent of patients with a controlled substance agreement increased from 13% to 83% (P < 0.001) and the percent of patients completing an annual urine drug screen increased from 17% to 53% (P < 0.001). The number of patients coprescribed benzodiazepines decreased from 1261 patients at baseline to 834 at completion. A total of 6.5% of patients were referred for additional support from a certified alcohol and substance abuse counselor embedded within the program. Overall, the comprehensive opioid management program provided the necessary structure to support opioid prescribing and resulted in improved adherence to best practices, facilitated weaning of opioids when medically appropriate, and enhanced support for patients with opioid use disorders.
Asunto(s)
Dolor Crónico , Trastornos Relacionados con Opioides , Humanos , Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Pautas de la Práctica en Medicina , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/prevención & control , Atención Primaria de SaludRESUMEN
Hierarchical Condition Categories (HCCs) are a common risk adjustment tool that may support alignment of care management resources with the clinical needs of a population. The authors examined the association between HCC scores and physician-determined clinical risk (CR) scores, annual charges, and utilization of medical care. CR score was defined as the anticipated risk for "ED or a hospital admission" within the following year. For each of the top 50 high-risk patients identified by total HCC score, the patient's primary care physician (PCP) entered a CR score based on their judgement. A total of 128 PCPs entered scores on 6167 patients of all ages across 31 primary care practices in the Finger Lakes Region of New York. Multiple correlation between HCC scores and physician CR scores was 44.0% (P < 0.001); only 18.5% of PCPs had a correlation >60%. There was a positive association between CR score and charges (slope 19.7K; P < 0.001) and between HCC score and charges (slope 25.7K; P < 0.001). Both HCC and CR scores were positively correlated (P < 0.001) with medical/surgical admissions, emergency department (ED) visits, and utilization of advanced imaging. Across a broad range of patients, HCC scores had a moderate-to-weak correlation with physician-determined CR scores for patients' risk of an ED visit or hospital admission. Both CR scores and HCCs scores were positively associated with charges and utilization. HCCs may assist in the allocation of health resources, but the relatively weak correlation with physician-determined CR scores warrants caution.