Background
Prescription opioids are a major contributor to the United States opioid epidemic. Opioid medications can be effective for pain when used cautiously in accordance with the Centers for Disease Control and Prevention prescribing guidelines, but overuse remains common and can lead to treatment failure, addiction, overdose, and death.
Using our accumulated expertise in addressing polypharmacy and medication safety, we set out to deploy a nationwide opioid stewardship program by leveraging our experience in addressing polypharmacy through med deprescribing, population outreach, and use of clinical technology to promote judicious opioid use and improve patient health outcomes.
Challenge
Negative health outcomes associated with opioids are especially likely when used under conditions of polypharmacy, a state of treatment which may be described as the use of multiple drugs prescribed by one or more physicians and filled by one or more pharmacies to treat one or more health conditions or diseases. Medication deprescribing is a practice which relates closely to polypharmacy, whereby medications that do not have a clinically appropriate purpose for use or whose risks and side effects alone or in combination with other medications have come to outweigh clinical benefits, are carefully removed.
8,675
Participants
64
Average age
18,738
Therapy problems identified
62%
Opioid-related therapy problems resolved
Solution
Design a program using a systematic, longitudinal, and technology-assisted approach to addressing factors contributing to negative health outcomes related to the use of chronic opioid therapy. Through targeted engagements with prescribers and patients over time, our goal was to resolve and prevent key therapy problems impacting population health.
Key elements:
- Clinical decision support
- Advanced outreach strategies
- Robust quality assurance
- Experienced clinicians
For the initial 12 months, we identified individuals at-risk for opioid overuse, opioid dependence, and opioid-related drug-drug and drug-disease interactions. Next, we set aside a control group to track progress from baseline and organized patients based on the complexity of their meds and average daily dose of opioids. With our patient population identified, organized, and stratified, we established multiple complementary clinical workflows to optimize interventions by our clinicians.
Results
We're thrilled to help address the difficult challenge of ensuring opioid stewardship, and these results further validate our approach and ability to improve health outcomes at scale.
Downer Dykes, Director of Quality, Analytics and Data Sciences
We identified 8,675 patients using opioids at moderate to high doses on a chronic basis who were also at high-risk for therapy problems connected to opioid use. In this population, the average age was 64 years, 51% female and 49% male. There were 18,738 therapy problems relating to drug interactions, polypharmacy, therapy gaps, and other interventions that directly or indirectly involved opioid medications. Over a 12-month period, the average daily morphine equivalent dose for patients decreased from 155.4 mg to 113.3 mg, for a 27% reduction that was validated against control. Additionally, over 62% of opioid-related therapy problems were resolved.
