Pain Management Program Cuts Long-Term Opioid Prescriptions by 64%

Richard Frazee, MD, FACS

The implementation of a pain management program reduced longer-term opioid prescriptions by two-thirds in 1 healthcare system in Central Texas, according to recent findings.

The program, implemented at Baylor Scott & White hospitals, reduced post-surgery opioid prescriptions of more than 5 days by 64%. Prescriptions decreased from 1228 in the 3 months before the program to 432 in the first 3 months of 2019.

Richard Frazee, MD, FACS, and colleagues established a standard of opioid prescriptions of <5 days after elective surgery to decrease the potential of addiction. The team deployed a program that consisted of using monthly surgical grand rounds to educate surgeons and anesthesiologists about the opioid epidemic and how post-surgery prescriptions contribute.

The pain management program also used the health system’s electronic health record (EHR) to monitor each provider’s prescribing practices and tied the measure to the quality component of their compensation after 6 months.

Frazee, a general surgeon at Baylor Scott & White Healthcare in Temple, Texas, and the team of investigators included 31,814 patients who had elective surgery at 1 of the hospitals within the system from January 2018-March 2019. Throughout the study period, a bigger proportion of prescriptions shifted from >5 days to <5 days.

Prescribing practices were monitored for each provider and evaluated every quarter. The first 2 quarters provided feedback for general awareness of surgeon practices. During the third quarter, the quality-related portion of compensation was tied to prescribing opioids for <5 days in a graded manner. Surgeons with compliance >95% who prescribed <5 days received the full compensation component.

Those with compliance of 91-95%, 87-91%, and <87% received a progressive quality compensation reduction of 25%.

Surveys were used to gauge patient satisfaction. One statement on the survey was “recommend this provider office” and patients could respond “yes, definitely,” “yes, somewhat,” or “no.” The investigators analyzed the responses by quarter to see if prescribing patterns affected satisfaction during opioid reduction.

Overall, the Frazee and the team studied 81 surgeons across 11 specialties.

At the start of the study, the rate of postoperative opioid prescriptions of <5 days was 81%. The rate increased each quarter to 82%; 86%; 89%; and 92% (P <.0001 for quarters 3-5).

There was also a corresponding and significant decrease of prescriptions of >5 days was observed in 1228; 1200 (P = .1257); 939 (P <.001); 633 (P <.001); and 432 (P <.001) in patients in a comparison of quarters 1, 2, 3, and 4 in 2018 and quarter 1 in 2019.

The scores of the patient satisfaction survey did not differ significantly overall or by interquartile comparisons.

The model proved to be effective at reducing opioid prescriptions of >5 days across the health system. The program could be used for other systems to be more uniform and address the topic of opioid addiction.

The study, “Postoperative Opioid Prescription Reduction Strategy in a Regional Healthcare System,” was published online in the Journal of the American College of Surgeons.