Highlights
- •Using interrupted time series analyses, we assessed whether the Washington State chronic opioid therapy guideline and complementary health plan initiatives to change opioid prescribing reduced opioid doses among COT patients in a health plan's group practice (n = 16,653) compared with its contracted care settings (n = 5,552) exposed to only state guideline changes.
- •From 2006 to June 2014, the percentage of COT patients receiving ≥120 mg morphine equivalent dose declined from 16.8% to 6.3% in the group practice versus 20.6 to 13.6% among COT patients of contracted physicians.
- •The proportion receiving excess opioid days supplied declined from 24.0 to 10.4% among group practice COT patients and from 20.1 to 14.7% among COT patients of contracted physicians.
Abstract
Avoiding high opioid doses may reduce chronic opioid therapy (COT) risks, but the
feasibility of reducing opioid doses in community practice is unknown. Washington
State and a health plan's group practice implemented initiatives to reduce high-dose
COT prescribing. The group practice physicians were exposed to both initiatives, whereas
contracted physicians were exposed only to statewide changes. Using interrupted time
series analyses, we assessed whether these initiatives reduced opioid doses among
COT patients in group practice (n = 16,653) and contracted care settings (n = 5,552).
From 2006 to June 2014, the percentage of COT patients receiving ≥120 mg morphine
equivalent dose declined from 16.8% to 6.3% in the group practice versus 20.6 to 13.6%
among COT patients of contracted physicians. The proportion receiving excess opioid
days supplied declined from 24.0 to 10.4% among group practice COT patients and from
20.1 to 14.7% among COT patients of contracted physicians. Reductions in prescribing
of high opioid dose and excess opioid days supplied followed state and health plan
initiatives to change opioid prescribing. Reductions were substantially greater in
the group practice setting that implemented additional initiatives to alter shared
physician expectations regarding appropriate COT prescribing, compared with the contracted
physicians' patients.
Perspective
Washington State and a health plan's group practice implemented initiatives to reduce
high-dose COT prescribing. Group practice physicians were exposed to both initiatives,
whereas the health plan's contracted physicians were exposed to only the statewide
changes. Reductions in prescribing of high opioid dose, average daily dose, and excess
opioid days supplied followed state and health plan initiatives to change opioid prescribing.
Reductions were substantially greater in the group practice setting that implemented
additional initiatives to alter shared physician expectations regarding appropriate
COT prescribing, compared with the contracted physicians' patients.
Key words
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Article info
Publication history
Published online: October 14, 2015
Accepted:
October 6,
2015
Received in revised form:
September 24,
2015
Received:
May 28,
2015
Footnotes
This research was supported by grants from Pfizer, the Patient-Centered Outcomes Research Institute (R-IHS-1306-02198, Von Korff), and the National Institute on Aging (AG034181, Von Korff, Principal Investigator).
M.V.K. is the Principal Investigator of grants to GHRI from Pfizer Inc that concern opioids. These grants also support work on this project by S.M.S., K.S., and R.L.W. S.M.S. has received funding from research grants awarded to GHRI by Bristol-Myers Squibb and Pfizer Inc. K.S. owns stock in Merck.
The remaining authors report no conflicts.
Identification
Copyright
© 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.
