Six ways to manage opioids in small, rural clinics

In a study group, the number of people on high-dose opioids decreased by 14 percent over 15 months.

In rural, disadvantaged populations, the opioid epidemic has taken its most devastating toll.

“Opioids tend to be prescribed more liberally in rural places than in cities and suburbs,” said Michael Parchman, a senior investigator at the MacColl Center for Health Care Innovation at Kaiser Permanente Washington Health Research Institute. He was the lead author of a study with researchers at the University of Washington School of Medicine that examined ways to help rural clinics in eastern Washington and central Idaho manage patients with chronic pain on long-term opioid therapy.

Their results were published July 8 in the Annals of Family Medicine.

In the study group, the number of people on high-dose opioids decreased from 2,065 to 1,776, a 14 percent decrease, over a 15-month span. The difference in the control group was 4.7 percent – from 1,797 patients on high-dose opioids to 1,712.

Laura-Mae Baldwin, a study co-author and UW professor of family medicine, said the results showed the power of working at a system level, not only with providers.

“A system change can impact providers and their teams as they seek to offer high quality care,” she said. “It’s about creating an environment where providers and patients can do their best work."

The "Six Building Blocks" intervention was based on a team approach. Each of the 20 clinics designated an opioid-improvement team that was coached by a practice facilitator and clinical consultant in making changes:

  1. Clinics and their leaders assessed how they were managing opioid patients and identified how they wanted to improve.
  2. They developed clear opioid-management policies, patient agreements, and defined workflows.
  3. They monitored the patient population.
  4. They planned for patient-centered visits.
  5. They identified resources for complex patients.
  6. They monitored results.

Teams shared their learnings during monthly conference calls. Clinicians and staff at each clinic were also invited to participate in twice-monthly teleconferences with a UW Medicine pain-medicine specialist.

“To have a fighting chance of solving the opioid crisis, we must restructure how healthcare teams work together,” said Parchman. “We need a systematic, team-based approach to redesigning care, supported by changes to clinic systems and team workflows across entire clinics.”

Materials detailing the intervention and how to implement it are publicly available and free. The Six Building Blocks program has been adopted and/or recommended by the Washington state Department of Health, Oregon Pain Guidance, and used by the Centers for Disease Control and Prevention.

The study’s participating clinics are part of the WWAMI region Practice and Research Network, which is funded by the UW Institute for Translational Health Sciences.

-- Bobbi Nodell, Media Relations, UW Medicine,

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