Examining the Effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program on Implementation of VA/DoD-Recommended Guidelines for Long-term Opioid Therapy in a Primary Care Chronic Pain Population

摘要

Objective. To describe the core elements of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) and examine its effectiveness at increasing adherence to six of the Veteran Affairs/Department of Defense (VA/DoD) recommended guidelines for long-term opioid therapy (LOT) among chronic noncancer patients seen in primary care (i.e., urine drug screens UDS, prescription drug monitoring program PDMP queries, informed consent, naloxone education/prescriptions, morphine equivalent daily dose MEDD, and referrals to non-pharmacological pain interventions). Design/Methods. A within-subjects comparison of outcomes was conducted between pre- and post-PC-POP enrollees (N = 25), as was a a between-subjects comparison to a comparison group (N =25) utilizing a six-month range post-index date of 10/1/2018 (i.e., between-subjects comparison at Time 2). Subjects. A convenience sample of adult veterans with chronic noncancer pain receiving opioid therapy consecutively for the past three months in primary care. Results. Results showed increased concordance with VA/DoD guidelines among those enrolled in the PC-POP, characterized by increased documentation of urine drug screens, prescription drug monitoring program queries, informed consent, naloxone education/prescriptions, and a decrease in MEDD among patients enrolled in the PC-POP. Conclusions. The PC-POP shows promise for increasing guideline-concordant care for providers working in primary care.