Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1019 — Improving Chronic Pain Care and Opioid Safety in VA Primary Care: Implementation and Evaluation of the Integrated Pain Team Clinic

Lead/Presenter: Jenny Tighe
All Authors: Seal KH (SFVAMC, UCSF) Rife T (SFVAMC) Li Y (SFVAMC) Tighe J (SFVAMC)

Objectives:
The Integrated Pain Team (IPT) clinic, embedded in primary care, integrates and co-locates pain-trained primary care providers (PCPs), psychologists and pharmacists to provide interdisciplinary, biopsychosocial pain care for patients with complex chronic pain and aberrant opioid use. PCPs refer and IPT providers assume short-term responsibility for pain care, conducting a warm hand-off back to the PCP for long-term pain management. Using a matched cohort design, we evaluated changes in daily prescription opioid use and other safety metrics among patients enrolled in IPT compared to those receiving usual primary care.

Methods:
Using a clinical performance dashboard, we examined 162 veteran patients: 81 enrolled in IPT versus 81 patients in usual primary care. All patients had chronic pain, were prescribed opioids and were matched on age, sex, psychiatric diagnoses, and baseline daily opioid dose. Patients were assessed at 3 months (n = 162) and at 6 months (n = 82).

Results:
At 3-months, mean daily opioid dose decreased by 41.2 mg in the IPT group compared to 24.8 mg in usual care (p = 0.020). Twice as many patients in IPT compared usual care (38 vs. 19 patients) reduced their daily opioid dose by >= 50% at 3 months, and the IPT group had a 2.6-fold higher odds of achieving >= 50% reduction in opioid use than usual care (p = 0.004). At 6 months, mean daily opioid dose further decreased by 57.8 mg in the IPT group compared to 14.2 mg in usual care (p = 0.017). Overall mean daily opioid dose of the IPT group was 103% lower than matched patients, and the IPT group had a 3.6-fold higher odds of achieving >= 50% reduction in opioid use than usual care (p = 0.005).

Implications:
Compared to usual primary care, the IPT clinical model led to significantly greater daily prescription opioid use reductions at 3 months with further reductions by 6 months. Other opioid safety metrics were similarly improved.

Impacts:
An interdisciplinary biopsychosocial pain care team, embedded in primary care, decreases opioid use and improves opioid safety in veterans with chronic pain and opioid misuse. Implementation and dissemination of IPT-like models across VA may lead to system-wide improvements in opioid risk reduction among veterans.