(435) Reducing opioid misuse among chronic pain patients in primary care

Abstract

There is increasing concern among primary care providers (PCPs) regarding medication misuse and noncompliance among chronic pain patients prescribed opioids for pain. This study investigated interventions designed to reduce opioid misuse and improve provider confidence in managing patients with chronic noncancer pain through the use of risk assessment, specialty support, and summary reports. Fifty-six PCPs and 253 chronic pain patients were recruited into the study. Patients were randomized to receive either comprehensive, team-based pain services (experimental group) or standard of care. All patients were followed for six months. Provider concerns, perceptions, and knowledge of managing chronic pain patients were assessed using the Background and Prescribing Practices Questionnaire, General Health Questionnaire, Opioid Therapy Survey (OTS), Concerns About Analgesic Prescriptions (CAAP), and Test of Opioid Knowledge (TOK). After one year, providers completed the OTS and CAAP and an Addiction Behavior Checklist for each patient enrolled in the study. Providers in the experimental group received monthly electronic assessments with a patient summary that consisted of pain, mood, activity levels, healthcare utilization, and results of the Opioid Compliance Checklist, while providers in the control group did not receive the monthly reports. Results demonstrated perceived improvement by PCPs in identifying patients at risk for misuse (p<0.05), perceived confidence in managing challenging pain patients (p<0.05) and increased satisfaction with communication with pain specialists (p<0.05). Despite these improvements, PCPs still reported reluctance to prescribe opioids for chronic noncancer pain. No other differences were found between treatment groups. Also, no significant differences in patient-reported pain or activity interference were found, but there was a reduction in patients taking opioids at the end of the study, and a significant decrease in the number of patients who reported running out of their medication early. This study demonstrates the benefits of careful monitoring of chronic pain patients within primary care.