AHRQ’s Opioid Medication Management Program Yields Positive Results

An AHRQ-funded opioid medication management program known as the Six Building Blocks led to a decrease in opioid prescribing, according to a study in the Annals of Family Medicine. After Six Building Blocks was used to redesign opioid medication management at 20 rural primary care clinics, the number of patients prescribed a 100-milligram or greater morphine equivalent dose daily, which determines a patient’s total intake of any opioid over 24 hours, decreased by 2 percent, and the number of patients on long-term opioid therapy fell by 14 percent during a 15-month period. Study authors noted that primary care health teams can use the Six Building Blocks framework to improve opioid-prescribing practices to be more consistent with current opioid guidelines.

2019 Jul;17(4):319-325. doi: 10.1370/afm.2390.

Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing.

Parchman ML1, Penfold RB2, Ike B3, Tauben D4, Von Korff M2, Stephens M5, Stephens KA6, Baldwin LM3.

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Abstract

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.