Article Figures & Data
Figures
- Figure 1.
Poster highlighting drug-related deaths in our practice catchment area.
Tables
Safe Opioid Prescribing for Pain Management Treating OUD Strategy: The plan of action to be used. • Develop shared general principles for safe prescribing of chronic opioids in accordance with expert recommendations that standardizes a team-based, clinic-wide approach • Develop team-based care to provide care for patients 6with OUD • Develop new curricula for residents and other clinicians in the practice • Institute office-wide medication-for OUD treatment with buprenorphine/naloxone and intramuscular (IM) naltrexone • Develop support systems among clinicians managing patients on chronic opioids for chronic pain • Foster a safe and welcoming environment that destigmatizes substance use disorders and approaches addiction as a neurobiological disease Systems: Daily activities and procedures instituted to get the job done • Create, implement, and monitor a policy for prescribing opioids, addressing: initiating prescribing, prescribing to legacy patients • Assure prescribers, preceptors, and residents (after first year) receive onsite buprenorphine waiver training • Develop a workflow to document opioid use on every problem list • Develop and institute group visits (shared medical appointments) for patients with OUD • Implement and enforce adherence to controlled substance agreements • Develop a workflow for centralized intake of all new patients for OUD treatment utilizing one full-time addiction nurse • Integrate mental health clinicians • Create a health system-wide list-serve to share best practices, ask questions, get further support around OUD management • Create a specialized, interdisciplinary referral service for complex patients with pain and/or addiction • Develop a referral system to specialized outpatient addiction services for selected patients • Create a monthly forum for discussion of difficult and complex patients • Institute team meeting time to discuss management decisions and revise logistical components of group-based management • Create a clinic workflow for medical assistants to check the prescription monitoring program, administer the pain functional assessment tool, and collect urine for drug screen monitoring Develop smart-phrases (“dot-phrases”) for our electronic medical record to aid with note writing and clinical decision-making and to aid in adherence to policies Structure: How our system is organized/who reports to who • Institution-wide chronic pain working group develops quality improvement metrics around safe prescribing behaviors • One lead physician and one full-time addiction nurse provide oversight to management of all patients with OUD • Medical director provides oversight of clinicians managing patients receiving chronic opioids • Designated dedicated interdisciplinary team provides group-based opioid treatment (shared medical appointments) Style: The style of leadership • Participatory leadership led by the clinic director • Centralized clinic interdisciplinary team with top-down leadership from lead physician and lead addiction nurse • Charismatic leadership provided by a key opinion leader • Mentorship for decision-making for patients with OUD is provided by an interdisciplinary care team, a separate consultation service, and a system-wide shared email list-serve for consultation questions Staff: The people and their special capabilities • Physicians, physician assistants, nurses, medical assistants, care partners (social workers), and primary care health psychologists, each with unique roles to care for patients at the individual level • A family physician obtained board certification in addiction medicine; a nurse completed enhanced addiction training • Physician assistant and back-up physicians assist with the oversight of managing patients with OUD A multidisciplinary consultation team with expertise complex pain/addiction problems Skills: Skills and competencies needed to get the job done • Curriculum to disseminate evidence-based guidelines and clinic-specific policies around safe opioid prescribing, nonopioid pharmacologic options, and nonpharmacological approaches • Buprenorphine training for all physicians • Care partners training to provide continuity and to teach nonpharmacological approaches to pain management • Naloxone administration training to all staff • Longitudinal addictions curriculum for residents • Reception staff training in the special needs of patients with OUD Medical assistant training in intake and urine collection Primary care behavioral health psychologists trained in collaborative management OUD, opioid use disorder.
