RUNNING OUT OF OPTIONS: IS ACCESS TO NON-PHARMACOLOGIC PAIN MANAGEMENT TREATMENTS LINKED TO OPIOID PRESCRIPTIONS?

The high prevalence of chronic pain and the rising opioid prescription rate impact the quality of life of older adults. Clinical guidelines recommend non-pharmacologic treatments over opioids for chronic pain. Evidence shows that opioids are used more than non-pharmacologic treatments, and opioid prescription practices differ geographically. Healthcare system characteristics can encourage or deter pain management practices. Therefore, the research objective was to understand if and how access to non-pharmacologic pain treatments is associated with opioid prescriptions patterns for older adults with a new episode of persistent musculoskeletal pain (lasting > three months). From a 5% sample of fee-for-service Medicare beneficiaries enrolled from 2007-2014, we constructed a cohort of beneficiaries over 65 with a new episode of persistent musculoskeletal pain and no opioid prescriptions within the prior six months. Using claims data and the Area Health Resource File, we defined access as the provider supply and service use for two common non-pharmacologic services, physical therapy (PT) and mental health (MH). In Aim 1, greater supply of non-pharmacologic providers was associated with lower odds of an opioid prescription in the first three months of an episode. PT during the first three months of an episode was associated with lower odds of an opioid prescription in following three months. In Aim 2, greater supply of MH providers was associated with lower odds of long-term prescriptions (≥90 days’ supply) and high-dose prescriptions (≥50 Milligrams Morphine Equivalent). In Aim 3, we explored how primary care providers in North Carolina operationalize caring for chronic pain patients as discrete responsibilities and the needs, supports, barriers, and priorities for change associated with each responsibility. Provider reported struggling to avoid prescribing opioids while trying to recommend non-pharmacologic treatments and discuss the relationship between pain and MH. Common supports included published literature, patient education, allied health professionals, electronic health records, and prescribing policies. Key barriers included poor insurance coverage and limited time. Priorities to improve chronic pain care were better patient education materials and more MH professionals. Taken together, the findings support polices that reduce shortages and engage patients in non-pharmacologic services to improve opioid prescribing practices for chronic pain.Doctor of Philosoph

Development and implementation of a prescription opioid registry across diverse health systems

Objective: Develop and implement a prescription opioid registry in 10 diverse health systems across the US and describe trends in prescribed opioids between 2012 and 2018. Materials and Methods: Using electronic health record and claims data, we identified patients who had an outpatient fill for any prescription opioid, and/or an opioid use disorder diagnosis, between January 1, 2012 and December 31, 2018. The registry contains distributed files of prescription opioids, benzodiazepines and other select medications, opioid antagonists, clinical diagnoses, procedures, health services utilization, and health plan membership. Rates of outpatient opioid fills over the study period, standardized to health system demographic distributions, are described by age, gender, and race/ethnicity among members without cancer. Results: The registry includes 6 249 710 patients and over 40 million outpatient opioid fills. For the combined registry population, opioid fills declined from a high of 0.718 per member-year in 2013 to 0.478 in 2018, and morphine milligram equivalents (MMEs) per fill declined from 985 MMEs per fill in 2012 to 758 MMEs in 2018. MMEs per member declined from 692 MMEs per member in 2012 to 362 MMEs per member in 2018. Conclusion: This study established a population-based opioid registry across 10 diverse health systems that can be used to address questions related to opioid use. Initial analyses showed large reductions in overall opioid use per member among the combined health systems. The registry will be used in future studies to answer a broad range of other critical public health issues relating to prescription opioid use