Prescribing policy principles developed based on analysis of medical practice manager survey and interview data
– A new report released today by Medical Group Management Association (MGMA) identifies three key focus areas – communication, technology and referral management – to help medical practices effectively reduce opioid prescriptions and risk of opioid misuse. The analysis in Combating the Opioid Epidemic: Effective Policies and Communication Strategies – An MGMA Research & Analysis report
, informed a set of opioid prescribing policy principles to assist medical practices in combatting the opioid crisis.
“The opioid epidemic has become an unprecedented crisis in the United States and, as such, Americans need to come together to develop comprehensive solutions — at all levels,” said Dr. Halee Fischer-Wright, President and CEO of Medical Group Management Association. “Our goal with this report was to find the best ways in which medical practices and healthcare providers — those on the frontlines — can drive meaningful parts of solving this crisis. Through our research, we’ve put forward both current best practices for, and barriers to, preventing prescription opioid abuse and treating addiction. By arming practice leaders and healthcare providers with this information, we’re hopeful that they can be even more effective in fighting this epidemic at one of the most critical junctures: the point of care.”
Through survey data, case studies, and in-depth interviews with practice leaders, MGMA discovered three key areas that define success for an effective opioid prescription policy:
- Communication – Lines of communication must be open and clear between all parties involved in the prescription process (patients, providers, staff, and pharmacists). This also includes ensuring these parties are fully aware of the proper use of opioids, and how to identify potential misuse.
- Technology – Opioid prescription policies are more effective when available technologies are leveraged to track prescriptions. Medical practices that use prescription drug monitoring programs (PDMPs) are better able to identify patients who have received opioid prescriptions from other providers. Additionally, the use of electronic prescriptions for controlled substances (EPCS) helps providers better track prescriptions and helps prevent fraudulent prescriptions from being filled.
- Referral Management –When providers have a good understanding of the capabilities and limitations of the specialists they refer patients to, patients are more likely to receive appropriate and satisfactory care, reducing the risk of turning to opioid prescriptions to manage pain rather than treat the underlying cause.
Based on the analysis of this research, MGMA developed the following set of key principles that all medical practices should follow to maximize success when developing or modifying an opioid prescription policy:
- Don’t make opioid therapy routine: Opioid therapy should not be a first-line therapy for chronic pain. If the expected benefits outweigh risks to the patient, opioid therapy should be combined with preferred nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.
- Know the care goals: Treatment plans should include when and how opioid therapy is discontinued as patients near their goals.
- Continuing education and evaluation: There is never a bad time to address the risks of opioid misuse with the patient, whether before beginning therapy or while managing therapy. An evaluation of benefits and harms of opioid use should occur between one and four weeks after the start of therapy or after any dosage increase.
- Use proper dosage/duration: Immediate-release opioids at the lowest effective dosage are preferred for starting therapy, prescribed in a quantity no greater than what is required for the duration of pain that is severe enough to require opioids.
- Know the risks: Clinicians should use state PDMP data for patients before starting an opioid therapy and periodically thereafter, whether at every prescription or as infrequently as every three months. Additionally, urine drug testing of patients should precede the start of opioid therapy, with subsequent testing (at least annually) after beginning therapy.
- Be ready to handle misuse: Practice clinicians who encounter patients with opioid use disorder should be ready to offer or arrange treatment, which frequently includes buprenorphine or methadone along with therapy for behaviors tied to substance misuse.