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WASHINGTON, D.C. — Community-based health plans are taking a variety of approaches to reduce the misuse of prescription painkillers while assuring patients in pain get the relief they need, according to a report released today by the Alliance of Community Health Plans (ACHP). Misuse of opioid painkillers accounted for more than 15,000 deaths in 2009 and adds more than $55 billion per year to health care and other costs. Health plans are working with physicians, pharmacists, patients and others to find ways to make sure these drugs are used appropriately.
“Prescription painkiller misuse takes a huge toll on the health and well-being of patients and our nation,” said ACHP President and CEO Patricia Smith. “This report demonstrates how community-based health plans are leading the way in finding successful approaches to curbing this epidemic.”
“Since day one, the Administration has been laser focused on the prescription drug epidemic,” said Office of National Drug Control Policy Director R. Gil Kerlikowske. “We commend the Alliance of Community Health Plans for its work to decrease prescription drug abuse. By working together and sharing innovative ideas such as improving provider and patient education systems and strengthening Prescription Drug Monitoring Programs across the country, we can ensure tangible progress is made toward curbing our nation’s abuse of prescription drugs.”
“Doing the right things for my patients and providing them with the right care is what my job is all about,” says Randi Beck, M.D., service line chief of physical medicine and rehabilitation, who is caring for a Group Health patient profiled in the report. One of Beck’s patients, “Mary,” is now on a tenth of her previous painkiller dose, and her quality of life has improved significantly. “This is exactly how [care is] supposed to be,” Beck says.
Kaiser’s opioid initiative “makes it easy to do the right thing and harder to do the wrong thing,” says Joel D. Hyatt, M.D., assistant medical director, Regional Quality and Clinical Analysis with the Southern California Permanente Medical Group (Kaiser Permanente).
“Our toolkit includes initiatives to address underlying physical, emotional, social and vocational issues that may be exacerbating or causing the pain,” says Stephen E. Perkins, M.D., vice president of medical affairs for UPMC. “We’re proud to report that in its first year, UPMC Health Plan’s Pain Management Program reduced prescription painkiller use by 13 percent for targeted patients.”
The report, “Ensuring Safe and Appropriate Prescription Painkiller Use: The Important Role of Community Health Plans,” profiles 16 ACHP member plans that are working closely with community-based organizations in states across the country.
Among the initiatives profiled in the report:
- Group Health Cooperative of Seattle, Wash., instituted chronic opioid therapy (COT) guidelines for non-cancer patients with pain that include training for doctors and nurses, development of a care plan for each patient, division of patients by dose and behavior, ongoing monitoring and referral and refill management. A care plan includes the patient’s diagnosis and goals for pain management, a discussion of risks/benefits of opioids, information on patients’ medication and dose, treatment plan and instructions for follow-up. Care plans become part of each patient’s electronic medical record.
- Kaiser Permanente of Southern California added a decision support tool to its electronic medical record that helps doctors decide which medicine to prescribe and determines patient and physician eligibility for a given opioid drug and dose. The tool enables physicians to carefully consider their prescribing choices, reminds them of any prescribing restrictions and notifies them of medication alternatives. To support its physicians, Kaiser Permanente (KP) has a controlled substances workgroup that aims to more formally implement opioid treatment policies. KP’s physicians also have regular educational programs about opioid prescribing at regional symposia and local education programs are provided for its professional staff.
- UPMC Health Plan of Pittsburgh, Pa., sends providers a comprehensive pain management toolkit including information about appropriate narcotic prescribing, patient assessments and screening tools for early identification of misuse, strategies for acute and chronic pain management, patient pain agreements, formulary and drug information and charts that help providers compare doses of different painkillers. The toolkit recommends non-pharmacological treatment for pain whenever possible, including initiatives to address underlying physical, emotional, social and vocational issues that may be exacerbating or causing the pain.
View the complete report, as well as longer profiles on individual members, on ACHP’s Publications page.