Reducing Opioid Overprescribing by Educating, Monitoring and Collaborating with Clinicians: A Quality Improvement Study

Abstract

Introduction Multiple barriers have been described for reducing opioid prescribing by primary care providers. We describe a quality improvement report on the effects of a series of focused interventions on opioid prescribing after the release of the Centers for Disease Control and Prevention (CDC) guidelines while monitoring patient satisfaction. Material and methods The study began as an intervention project to inform and educate providers about the CDC's guidelines and to improve adherence. A convenience sample of 165 providers from 33 outpatient clinics of a healthcare system was utilized. This quality improvement study compared a 20-month preintervention baseline period with a 16-month post-intervention period ending on December 31, 2017, using the health system's electronic medical record. Interrupted time series analysis was used to assess the effect of the intervention on opioid prescribing. Providers were given quarterly individual reports on their prescribing patterns of schedule II opioids and comparing their prescribing patterns to their peers. Providers had access to educational opportunities for CDC guidelines, various aspects of safe opioid prescribing, and professionally written patient hand-outs about opioid risks and alternatives. Provider collaboration with patients for tapering opioids and collaboration with specialists in managing complex pain patients was encouraged. A total number of schedule II chronic opioid prescriptions per month was measured. Results The total schedule II opioid prescription rate was 19.6% lower than the average of the baseline. Every month after August 2016, there was a significant reduction of total schedule II opiate orders with a risk decrease of 2% [risk ratio (RR) 0.982; 95% confidence interval (CI) 0.976-0.989; p < 0.0001]. The patient satisfaction scores improved from 92.1 % in January 2015 to 95.1% by December 2017. Discussion We noticed an initial decrease in opioid prescribing with the release of the CDC guidelines. However, a greater decline in opioid prescribing was noted after distributing data to providers that compared their own opioid prescribing patterns to their peers. This data offered an opportunity for self-analysis to clinicians to justify the clinical reasons for writing more opioid prescriptions. Provider and patient education on the benefits of opioid reduction enabled better collaboration and engagement in shared decision making with a detailed plan of gradual opioid reduction. Our study was limited by the inability to determine the most effective intervention as the interventions were initiated as a bundle in our healthcare system. Indications for opioid therapy such as pain management for cancer pain or palliative care versus chronic non-cancer pain were not available. The major adverse events related to opioid use, such as opioid overdose deaths and opioid use disorder, were not measured in this data source. Conclusions Opioid overprescribing was reduced by educating providers and patients, monitoring clinicians' opioid prescribing patterns, and seeking physicians' collaboration. Future healthcare initiatives can utilize similar methods to evaluate interventions impacting the opioid epidemic.