PinnacleHealth’s initiative helps reduce opioid prescriptions in primary care setting

PinnacleHealth Medical Group, a network of more than 200 primary care providers and specialists, singled out opioid abuse epidemic and initiated a formal opioid reduction program in 2014. Since the program's rollout, the group's average number of prescriptions per month for controlled substances has been drastically reduced.

At the beginning of the initiative, the monthly average number of prescriptions written for opioids with the medical group was 3,982. Today, that monthly average has been reduced by 20 percent, while the number of providers within PinnacleHealth Medical Group grew by 22 percent and the number of patients grew by 12 percent.

Cathleen Veach, MD, clinical quality officer for the PinnacleHealth Medical Group, recently shared insights from the PinnacleHealth opioid reduction initiative at The Leadership Institute in Washington, DC.

"The core of our efforts focused on awareness, education and patient safety. We are asking more questions about how pain affects life goals such as work, relationships, activities and mood and tailoring treatment plans and goals accordingly. We are recommending alternatives and revising treatment plans when appropriate and taking steps to prevent nonmedical use and abuse of prescription narcotics," states Dr. Veach. "Open communication between patients and providers is the cornerstone of medication safety, particularly in preventing opioid abuse."

Drug overdose in the United States increased by seven percent in 2014 and accounted for a total of 47,055 deaths. According to the CDC, 61 percent of those deaths involved some type of opioid, including heroin. Of the 110 people who die of a drug-related overdose each day in the U.S., seven are Pennsylvanians. Much of this abuse is related to prescription narcotics.

Prescription Reduction Tactics
The PinnacleHealth Medical Group's formal opioid reduction program is comprehensive and based on evidence-based guidelines. Some of the highlights include:
•Formation of a Controlled Substance Committee which includes a pharmacist, physician and advanced care practitioners, a pain specialist and the chief quality officer.
•Monitoring and reporting of dosing and prescriptions
•Development of medical group controlled substances guidelines
•Creation of controlled substance contract for patients
•Comprehensive and continuous evaluation and documentation in the electronic medical record (EMR), including templates to guide treatment goals and routine visit documentation

More resources were offered to providers to better manage patients' prescription use, such as urine drug screens, a prescription pick-up policy, pill counts and the Pennsylvania Prescription Drug Monitoring Program. PinnacleHealth Medical Group also focused its efforts on educating providers on tapering techniques and morphine equivalents to ensure safe prescribing.

A population health nurse was added to the team to assist with addiction management and tapering by monitoring patient progress and conducting home visits. Moving forward, a clinical pharmacist will be practice-based to assist providers with tapering guidelines for patients. In addition, a medical toxicologist and addiction specialist will rotate within primary care practice settings to assist with addiction recovery services.

"Controlling the opioid abuse crisis requires a new way of thinking and taking action. Only by making alternative therapies a real possibility for most patients will we be able to prescribe workable, non-pharmaceutical options for helping patients relieve chronic pain," states Michael Young, president and CEO, PinnacleHealth System.