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P-092 - Weekly Opioid Shared Medical Medication Monitoring Appointments To Remediate Issues Of Chronic Pain Patient Adherence, Aberrance And Noncompliance.

POSTER ABSTRACT
Location:  Exhibit Hall
Abstract Title: Weekly Opioid Shared Medical Medication Monitoring Appointments To Remediate Issues Of Chronic Pain Patient Adherence, Aberrance And Noncompliance

Background: Chronic opioid therapy adherence, aberrance and compliance events identify risks of patient harm and increased prescriber liability (Green et al., 2015)(Turk et al., 2008)(Voles, et al., 2015). Events include appointment no shows, UDT exceptions, incomplete questionnaires, unknown PDMP medications or prescribers, and early refills. A reduced duration monitoring and compliance exception process was implemented decreasing from monthly opioid prescriptions to weekly prescriptions, conducted through shared medical telemedicine appointments.

Purpose/Objectives: To assess the adherence impact of weekly monitoring and treatment cycles for opioid exception management and to define the requirements to support the ongoing process.


Methods: Retrospective EMR review including data abstraction.


Results: 355 patients were evaluated for opioid compliance based on practice medication safety contracts between the patient and their opioid prescriber. 70 patients were not in compliance with the terms of the agreement.. Among non-compliant patients, 54% (38) of the patients resolved their noncompliance behavior during the study period after attending weekly medication monitoring shared medical appointments that included a weekly opioid prescription cycle instead of a 30 day prescription. 20% (14) demonstrated improved compliance. 26% are still working to either return to compliance, or pursue a different, non-opioid treatment plan (Disenrolled), and 19% (13) were Disenrolled.



The Disenrolled patient group, 19% (13), had a higher average MME and made their treatment decisions more quickly, in 1 treatment cycle (45 days) on average versus 3.4 - 3.9 treatment cycles for the other groups. These patients opted for different treatment plans with 54% (7) of these patients tapering off of opioids completely.

Patient compliance across the practice increased from 80% (285/355) to 87% (310/355) and is trending to 91%, reducing practice, prescriber and patient related LTOT risk.



The median MME of the group reduced from 200 to 32 and the max was reduced from 960 to 133.

Conclusions/Implications for future research and/or clinical care: Moving into a group treatment model standardizes medical management and clinical decision processes. Increased interventions supported by new information is consistent with traditional practice, increasing visit frequency to manage higher risk. Future work will focus on the appropriate transition point from a monthly care model to a weekly care model to optimize opioid

risk vs. benefit. Earlier identification and management of opioid non-compliance can improve transition to more appropriate chronic pain treatment options.

Weekly risk based adherence and compliance groups enable the prescriber to more easily identify, target, assess, and resolve noncompliance through increased communication with the patient. While 46% (32) of the initial non-compliant patients have not yet resolved compliance, over time they will either return to compliant, or be transitioned to more appropriate therapies. The Disenrolled group needed different therapies which was not apparent to the prescriber in the regular monthly visit cycle.


References:


  1. Green, T. C., Bowman, S. E., Ray, M., Zaller, N., Heimer, R., & Case, P. (2015). Collaboration or coercion? Partnering to divert prescription opioid medications. Journal of Urban Health, 92(4), 606-612.



  2. Turk, D. C., Swanson, K. S., & Gatchel, R. J. (2008). Predicting opioid misuse by chronic pain patients: a systematic review and literature synthesis. The Clinical Journal of Pain, 24(6), 497-508.



  3. Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., Ney, J. P., & van der Goes, D. N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain, 156(4), 569-576.