Description of the Change Elements Addressed using the 7S Model
| 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.