Opioid Prescribers Group/Oregon Pain Guidance (2010-2015)

Focus Area: Pain Management and Issues Surrounding Opioid Over-Prescribing
Project Title: Oregon Pain Guidance (OPG) www.oregonpainguidance.org

Community Champions

Jim Shames, MD, Jackson County HHS; John Kolsbun, MD, All Care Medical Director; Laura Heesaker, LCSW, Ginger Scott RN, Jackson Care Connect

OPG Steering Committee Leadership

Jim Shames MD, Jackson HHS; Laura Heesaker, LCSW, Jackson Care Connect; Sara Smith, RN, La Clinica; John Kolsbun MD, AllCare;  Ginger Scott RN, Jackson Care Connect; Michele Marikos, Peer to Peer Facilitator; BJ Lynch MD, Asante Jo Co; Anne Alftine MD, Jackson Care Connect; Michele Schaefer, DOJ grant administrator; Nadejda Razi Roberson, LCSW.

OPG Monthly Professional Meetings

Average 40-50 attendees between Ja & Jo County including La Clinica, Rogue Community Health, Siskiyou Community Health Clinic, Asante Physician Partners, Veterans Administration, private practices in Primary Care, Addictions Recovery Center, On Track, Kolpia Counseling, Phoenix Counseling Center, Allied Health, Ja Co Mental Health, Options for SO, CCOs:  Jackson Care Connect, All Care, Primary Health. Participants represent:  JaCo & JoCo Primary Care clinicians, behavioral and mental health practitioners, and addiction service professionals, pain specialists, dentists, pharmacists, nurses, medical assistants, outreach workers. CME credits are provided and managed through Asante.

The professional email list for education and ongoing information sharing is over 250 and growing monthly.

JRHA Relationship

JRHA acts as a fiscal agent for OPG grants as requested. During this 3rd quarter of 2015, JRHA has provided administrative support for strategic planning through staff time of JRHA Collaboration Manager Angela Warren. (Vanessa Becker facilitated morning planning session for stakeholders in April/May)

Scope of Project

Jackson and Josephine County residents and healthcare provider community. Contacts for assistance come from throughout Oregon and beyond at this time.

Goals

  1. Raise awareness and provide education in a comprehensive way about living with chronic pain in order to gain the understanding and support of our patients and larger community.
  2. Promote safety and self-sufficiency in the management of chronic pain for individuals in our community.
  3. Reduce high mortality rates associated with usage of high doses of opioids among those prescribed for chronic pain.
  4. Decrease the total number of opioid medications prescribed to patients with chronic pain.
  5. Support physicians and clinics in making changes within their practices around established prescribing guidelines.
  6. Improve patient health outcomes and health provider options for patient care around chronic pain.
  7. Create a multidisciplinary, collaborative approach in our community to serve patients with chronic pain.
  8. Create a systems approach to coordination of care across the continuum.

Desired Outcomes

I. Change consumer/patient behavior as recognized by the following:

-Quality of life increases for thoses with chronic pain

  • Functional status improved
  • Pain stabilized and managed
  • Care plan goals reached
  • Decreased unemployment
  • Quality adjusted life years improved

- Community understanding increases regarding chronic pain, its treatment options, opioid risks, and goals/outcomes of care

- Patient’s ability to respond to (and take responsibility for) their personal health needs increases

- Mental Health and Addiction co-morbidities are recognized in the primary care setting for patients with chronic pain and opioid use

- Collaborative and multidisciplinary, patient centered treatment plans are created for those with chronic pain.

II. Change provider/prescriber behavior

- Jackson/Josephine County medical provider adoption of the opioid prescribers group’s community standards is at 90+%

--Provider capacity is increased for OPG guideline implementation

-Access for patients with chronic pain is supported through multidisciplinary approach in the primary care office

- Support is available for provider offices to create team based care through training, education, and tools

- Number of opioid pills prescribed decreases

III. System Change

- Multidisciplinary, collaborative teams are created across organizations in our community to coordinate care for patients with chronic pain.

- Opioids as cause of death decrease

-Organizational barrier/silos are decreased improving outcomes for patients with chronic pain

- ED utilization drastically reduced for chronic pain opioid requests

-Regular and ongoing conversations between providers and payerspromote efficient patient centered care improving outcomes and decreasing overall costs

-Increase the quality of life for Jackson & Josephine County citizens through a greater understanding and improved treatment of chronic pain through appropriate prescribing and safe use of opioid medication.

-We will see engagement of both the consumer and providers of care in this system change. Mortality, morbidity related to opioids will decrease.

Accomplishments/ Activities/Milestones 3rd Quarter 2015

  • A robust web presence www.oregonpainguidance.org; As of July, OPG is in discussion with Portland Tri-County Pain Group to expand OPG website statewide by building modules specific to each region while establishing shared educational resources, standards and guidelines as possible
  • Continued providing community and clinician practice education and support in both counties
  • Created a KOBI community campaign about opioid over prescription, and in July this PSA campaign expanded to KDRV with the creation of several additional spots produced at KOBI with DOJ funds (new spots include messaging about pain management alternatives)
  • Dr. Jim Shames works closely with the Oregon Medical Board to support local providers who find themselves in trouble with opioid over-prescribing.
  • The successful transition of the Peer-to-Peer Support Program/Group moving under the umbrella of The Oregon Pain Advisors- Pain Resiliency Program
  • Community Monthly OPG meetings now themed with a “topic of the month”
  • OPG has provided ongoing support to the newly emerged Pain Resiliency Program (PRP).  The PRP is hosting a community Open House on Sept 14
  • Encouraged the use of naloxone throughout the community to reduce accidental opioid overdoses.  Naloxone now in every Medford Police Department patrol car and the Sheriff’s Office is working on doing the same. All the other jurisdictions (Eagle Point, Central Point, Rogue River, Phoenix Talent, and Ashland PD) have expressed interest in carrying naloxone The Health Dept. is committed to providing naloxone as part of a rejuvenated needle/syringe exchange program. Allied Health is moving ahead with providing naloxone to their clients and Dr Shames will be assisting with training the staff trainers.

Key Learning 2015

  • “Brief Detailing” appears to be better than embedding staff into medical practices.
  • Provider and clinic outreach supports need to be nimble, responsive, and flexible as to match the provider/clinic’s “readiness for change”
  • It is crucial that work force development in the area of integrated behavioral health and safe/effective treatment for chronic pain are addressed simultaneously.
  • Pain Specialists need specialized outreach and relationship building.
  • Providers of care and the community need to understand the latest thinking regarding the appropriate ways to manage chronic pain, in order to achieve the goals previously listed.

2015 Obstacles/Opportunities

  • Need Strategic Plan to establish where we want to be on this issue in three years and what we need to do to get there.
  • Need to engage OMB in the process to ensure our region does not lose medical providers as the new guidelines take effect.
  • ignificant community culture change takes time and continuous stewardship.
  • Sustainability model needs further development for true integration of Behavioral Health into primary care.

August 2015 Update

  • Second Annual Living with Chronic Pain Community Forum 125 to 150 expected to attend.
  • Fourth Annual Pain two-day CME conference -170-200 expected to attend.
  • KOBI 5 minute patient living with chronic pain video completed
  • Assisted with the successful transition of the Peer-to-Peer Support Program/Group moving under the umbrella of The Oregon Pain Advisors- Pain Resiliency Program
  • See attached graph/table
  • Community/Stakeholder planning process underway with multiple meetings competed and a three year Vision and implementation plan for guidelines integration, patient support and changes in the population data completed (will this be done by June 3rd when Kathy goes to her big meeting?)
  • OPG website enhanced with the addition of special sections for Patients/Families and Healthcare Professionals, including additional resources for all
  • Community Monthly OPG meetings now themed with a “topic of the month”. Topics already competed include; Oregon Medical Board Collaboration and Trauma Informed Treatment for Chronic Pain. Upcoming monthly themes to include: Benzodiazepines, Marijuana, and Chronic Pain, and Motivational Interviewing.
  • PDSA proposal submitted to the Oregon Medical Board allowing OPG to provide “official” support to medical providers and their clinics before they are sanctioned to completely stop prescribing chronic opioid therapy.
  • OPG has provided ongoing support to the newly emerged Pain Resiliency Program (PRP).  The PRP program has had 65 referrals to date.  There have been numerous personal contacts in the form of Orientations, Assessments and Group Sessions.
  • Met with all local pain specialists in a special “Pain Specialists Summit” to engage in conversation around local pain specialists adopting the OPG guidelines. All local pain specialists agreed to collaborative quarterly meetings to move agenda forward.
  • Encourage the use of naloxone throughout the community to reduce accidental opioid overdoses.  We have instituted naloxone in every Medford Police Department patrol car.  Since March there have been 4 saves by the MPD deputies.  The Sheriff is working on doing the same and the technical issues have been resolved.  We expect to have naloxone in the Sheriff's cars within the month.  All the other jurisdictions (Eagle Point, Central Point, Rogue River, Phoenix Talent, and Ashland PD) have all expressed interest in carrying naloxone as well. There is a meeting this week with the officers involved in the "saves".  The Health Dept. is committed to providing naloxone as part of a rejuvenated needle/syringe exchange program.  Funding options are being explored but regular meetings have been occurring and there is definite momentum on this issue.  Allied Health has been approached and is interested in having naloxone at their site.  Nursing students from OHSU have taken the lead on this and it is in discussion.  We are at the preliminary stages of providing naloxone at the EDs when a patient overdoses on opioids.

2015 Next Steps and Timeline

  • A Summary and Strategic Directions report will be developed for the initiative to transition to being integrated into the community institutions and organizations that can build on its past success, expand the reach, and leverage resources to ensure long-term sustainability, and provide the greatest impact.