Improving Chronic Opioid Management in Primary Care

Has your clinic experienced the loss of a patient due to an opioid overdose? Have staff members voiced confusion about how patients on long-term opioid therapy are managed or expressed feelings of frustration and stress related to caring for this patient population? These challenges are real and unfortunately, can be devastating. However, there are proven actions clinics can take to address these concerns while improving the quality and safety of patient care delivery for their chronic pain patients on long-term opioid therapy.

The number of drug overdose deaths in the U.S. has continued to climb year over year, killing a record high of more than 107,600 Americans in 2021, during the continuing COVID-19 pandemic. The provisional 2021 data shows that approximately 75% of those deaths involved opioids (U.S Overdose Deaths In 2021 Increased Half as Much as in 2020 – But Are Still Up 15% ( Fentanyl, a synthetic opioid, was involved in more than 60% of overdose deaths during that period (APS NEWS: July 14, 2021).

Primary care providers account for nearly half of all dispensed opioid prescriptions and their prescribing rates have increased at high rates compared to other specialties, according to the CDC (Providers’ Frequently Asked Questions | CDC’s response to the Opioid Overdose Epidemic | CDC). As many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction (Prescription Opioids | CDC’s Response to the Opioid Overdose Epidemic | CDC). Given that anyone who uses opioids for long-term management of chronic pain is at risk for opioid addiction and overdose, preventing harm in this population of patients must be a priority (Opioid Overdose Toolkit | SAMHSA Publications and Digital Products).

Primary care practices are uniquely positioned to address and improve long-term opioid therapy for chronic pain patients despite the challenging environment they continue to face. A team of clinical researchers from the University of Washington Department of Family Medicine and the Kaiser Permanente Washington Health Research Institute developed the Six Building Blocks Opioid Management Program, an evidence-based quality improvement roadmap to help Primary Care clinics and practices implement consistent, patient-centered care for this patient population.

Implementation of the Six Building Blocks Program has demonstrated quantitative improvements in patient care and safety and qualitative improvements in patient, provider, and staff experiences. The Six Building Blocks Program offers a proven approach to reducing the number of patients on chronic opioid therapy and the proportion of patients on high-dose opioids. Clinicians and staff have found that by having a defined care pathway through the Six Building Blocks Program, they experience less stress and confusion while delivering more consistent, team-based patient care and services. In addition, the chronic pain patient they serve have reported improved functional status without worsening pain levels.

The Six Building Blocks Program incorporates six core elements for practice redesign to improve the overall management of chronic pain patients on long-term opioid therapy. The six core elements include:

  • Provide supportive leadership and build consensus.
  • Revise, align, and improve clinic policies, patient agreements, and workflows to improve opioid prescribing and care of chronic pain patients.
  • Track and monitor patient care for all patients on chronic opioid therapy.
  • Prepare for planned, patient-centered visits incorporating empathic patient communications.
  • Develop resources for “complex” patients with a focus on patients with opioid use disorder and/or behavioral health needs.
  • Measure for continuous improvement and celebrate the successes of a team-based approach to care delivery.

Primary Care clinics and practices embarking on the Six Building Blocks Program journey not only simplify their practices through decreased variation and increased efficiencies but also create a safer and more predictable environment for their patients. The goals are to treat all patients within defined clinical guidelines and without stigma and to decrease each patient’s risk of harm while increasing their potential for an improved quality of life.