• Margaret K Pasquale, Richard L Sheer, Jack Mardekian, Elizabeth T Masters, Nick C Patel, Amy R Hurwitch, Jennifer J Weber, Anamaria Jorga, and Carl L Roland.
• Research Manager, Comprehensive Health Insights, Inc., Louisville, Kentucky.
• J Opioid Manag. 2017 Sep 1; 13 (5): 303-313.

ObjectiveTo evaluate the impact of a pilot intervention for physicians to support their treatment of patients at risk for opioid abuse.Setting, Design And Patients, ParticipantsPatients at risk for opioid abuse enrolled in Medicare plans were identified from July 1, 2012 to April 30, 2014 (N = 2,391), based on a published predictive model, and linked to 4,353 opioid-prescribing physicians. Patient-physician clusters were randomly assigned to one of four interventions using factorial design.InterventionsPhysicians received one of the following: Arm 1, patient information; Arm 2, links to educational materials for diagnosis and management of pain; Arm 3, both patient information and links to educational materials; or Arm 4, no communication.Main Outcome MeasuresDifference-in-difference analyses compared opioid and pain prescriptions, chronic high-dose opioid use, uncoordinated opioid use, and opioid-related emergency department (ED) visits. Logistic regression compared diagnosis of opioid abuse between cases and controls postindex.ResultsMailings had no significant impact on numbers of opioid or pain medications filled, chronic high-dose opioid use, uncoordinated opioid use, ED visits, or rate of diagnosed opioid abuse. Relative to Arm 4, odds ratios (95% CI) for diagnosed opioid abuse were Arm 1, 0.95(0.63-1.42); Arm 2, 0.83(0.55-1.27); Arm 3, 0.72(0.46-1.13). While 84.7 percent had ≥1 psychiatric diagnoses during preindex (p = 0.89 between arms), only 9.5 percent had ≥1 visit with mental health specialists (p = 0.53 between arms).ConclusionsAlthough this intervention did not affect pain-related outcomes, future interventions involving care coordination across primary care and mental health may impact opioid abuse and improve quality of life of patients with pain.

48 keywords...

hide…