Key Components of Opioid Risk Reduction Initiatives and Selected Measures of Adherence to Risk Reduction Initiatives
| Source | Intervention Clinics | Control Clinics |
|---|---|---|
| Washington State COT Guideline (enacted as law in March 2010)18 | ||
| Check appropriateness of pain treatment | X | X |
| Screen for drug abuse and diversion | X | X |
| Group Health Opioid Risk Reduction Initiatives18,20,50 | ||
| Decrease COT dose (intervention clinic dose decreased from 74 mg MED to 46 mg MED versus control clinic decrease from 89 mg MED to 74 mg MED) | X | |
| Online CME followed by 1-hour discussion in each intervention clinic (87% of primary care providers participated) | X | |
| Medical staff leader advocacy | X | |
| Designated physician to manage COT and expert consultation for physicians in each primary care clinic | X | |
| Practice education tools (eg, patient education materials, care plan template, online calculator to estimate MED) | X | |
| COT care plans documented in the EHR and financial incentive for completing the plans (documented care plans increased from 10% to over 80% over the course of the intervention) | X | |
| Guideline-based monitoring visits and urine drug screening (urine drug screening increased from less than 15% in both intervention and control clinics to about 50% in the intervention clinics and less than 20% in the control clinics) | X | |
| 28-day-maximum opioid prescription and 5-day refill notice | X | |
COT, chronic opioid therapy; MED, morphine equvalent dose; CME, continuing medical education; EHR, electronic health record; X, component was used in these clinics.