Documented Items Required to Determine the Level of Appropriateness for Opioid Prescribing Preintervention and Postintervention among Patients with Chronic Noncancer Pain
| Item | Preintervention (N = 177) | Postintervention (N = 96) | P Value | Further Definitions |
|---|---|---|---|---|
| Overall level of appropriateness score, mean (SD) | 5.54 (1.23) | 6.29 (1.26) | <.001 | Opioid appropriateness score (out of nine) was calculated based on the number of documented items described below. |
| Documented items required: | ||||
| (1) Use of nonpharmacologic methods, N (%) | 129 (72.9) | 82 (85.4) | .023 | Utilized either physical therapy or osteopathic manipulative treatment. |
| (2) Specialist consultation, N (%) | 126 (71.2) | 66 (68.8) | .680 | Specialist consultation warranted if on methadone, >120 morphine equivalents, or >2 psychiatric conditions. |
| (3) Imaging/EMG/labs to identify pain generator, N (%) | 137 (77.4) | 80 (83.3) | .275 | For the purpose of identifying CNCP being treated with opioids. |
| (4) Use of nonopioid medications, N (%) | 172 (97.2) | 95 (99.0) | .669 | For the purpose of identifying CNCP being treated with opioids. |
| (5) Visit to discuss CNCP at least every 6 months, N (%) | 160 (90.4) | 90 (93.8) | 0.494 | |
| (6) Pain level/therapeutic/functional goals discussions, N (%) | 56 (31.6) | 66 (68.8) | <.001 | Discussed during the last patient's medical encounter for CNCP. |
| (7) UDS within last year, N (%) | 29 (16.4) | 24 (25.0) | .109 | |
| (8) Pain contract/agreement within past year, N (%) | 9 (5.1) | 12 (12.5) | .034 | |
| (9) Documented details on drug use, substance abuse or detox, N (%) | 162 (91.5) | 89 (92.7) | .819 | At any time prior to or at the reviewed medical encounter. |
EMG, electromyogram; CNCP, chronic noncancer pain; SD, standard deviation; UDS, urine drug screen.