TY - JOUR
KW - interdisciplinary
KW - Opioids
KW - pain
KW - primary care
KW - Veterans
AU - K. H. Seal
AU - T. Rife
AU - Y. Li
AU - C. Gibson
AU - J. Tighe
A1 - 
AB - BACKGROUND: National guidelines advise decreasing opioids for chronic pain, but there is no guidance on implementation. OBJECTIVE: To evaluate the effectiveness of an Integrated Pain Team (IPT) clinic in decreasing opioid dose and mitigating opioid risk. DESIGN: This study prospectively compared two matched cohorts receiving chronic pain care through IPT (N = 147) versus usual primary care (UPC, N = 147) over 6 months. Patients were matched on age, sex, psychiatric diagnoses, and baseline opioid dose. PATIENTS: Veterans receiving care at a VA medical center or VA community-based clinics. INTERVENTION: Interdisciplinary IPT, consisting of a collocated medical provider, psychologist, and pharmacist embedded in VA primary care providing short-term biopsychosocial management of veterans with chronic pain and problematic opioid use. MAIN MEASURES: Change in opioid dose expressed as morphine equivalent daily dose (MEDD) and opioid risk mitigation evaluated at baseline, 3 months, and 6 months. KEY RESULTS: Compared with veterans receiving UPC, those followed by IPT had a greater mean MEDD decrease of 42 mg versus 8 mg after 3 months and 56 mg versus 17 mg after 6 months. In adjusted analysis, compared with UPC, veterans in IPT achieved a 34-mg greater mean reduction at 3 months (p = 0.002) and 38-mg greater mean reduction at 6 months (p = 0.003). Nearly twice as many patients receiving care through IPT versus UPC reduced their daily opioid dose by ≥50%, representing more than a two-fold improvement at 3 months, which was sustained at 6 months [odds ratio = 2.03; 95% CI = 1.04-3.95, p = 0.04]. Significant improvements were also demonstrated in opioid risk mitigation by 6 months, including increased urine drug screen monitoring, naloxone kit distribution, and decreased co-prescription of opioids and benzodiazepines (all p values < 0.001). CONCLUSIONS: Interdisciplinary biopsychosocial models of pain care can be embedded in primary care and lead to significant improvements in opioid dose and risk mitigation.
AD - San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA. Karen.Seal@va.gov.; Departments of Medicine and Psychiatry, University of California, San Francisco, San Francisco, CA, USA. Karen.Seal@va.gov.; San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA.; Departments of Medicine and Psychiatry, University of California, San Francisco, San Francisco, CA, USA.; San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA.; San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA.; Departments of Medicine and Psychiatry, University of California, San Francisco, San Francisco, CA, USA.; San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA.
BT - Journal of general internal medicine
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 4
DO - 10.1007/s11606-019-05572-9
IS - 4
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: National guidelines advise decreasing opioids for chronic pain, but there is no guidance on implementation. OBJECTIVE: To evaluate the effectiveness of an Integrated Pain Team (IPT) clinic in decreasing opioid dose and mitigating opioid risk. DESIGN: This study prospectively compared two matched cohorts receiving chronic pain care through IPT (N = 147) versus usual primary care (UPC, N = 147) over 6 months. Patients were matched on age, sex, psychiatric diagnoses, and baseline opioid dose. PATIENTS: Veterans receiving care at a VA medical center or VA community-based clinics. INTERVENTION: Interdisciplinary IPT, consisting of a collocated medical provider, psychologist, and pharmacist embedded in VA primary care providing short-term biopsychosocial management of veterans with chronic pain and problematic opioid use. MAIN MEASURES: Change in opioid dose expressed as morphine equivalent daily dose (MEDD) and opioid risk mitigation evaluated at baseline, 3 months, and 6 months. KEY RESULTS: Compared with veterans receiving UPC, those followed by IPT had a greater mean MEDD decrease of 42 mg versus 8 mg after 3 months and 56 mg versus 17 mg after 6 months. In adjusted analysis, compared with UPC, veterans in IPT achieved a 34-mg greater mean reduction at 3 months (p = 0.002) and 38-mg greater mean reduction at 6 months (p = 0.003). Nearly twice as many patients receiving care through IPT versus UPC reduced their daily opioid dose by ≥50%, representing more than a two-fold improvement at 3 months, which was sustained at 6 months [odds ratio = 2.03; 95% CI = 1.04-3.95, p = 0.04]. Significant improvements were also demonstrated in opioid risk mitigation by 6 months, including increased urine drug screen monitoring, naloxone kit distribution, and decreased co-prescription of opioids and benzodiazepines (all p values < 0.001). CONCLUSIONS: Interdisciplinary biopsychosocial models of pain care can be embedded in primary care and lead to significant improvements in opioid dose and risk mitigation.
PY - 2020
SN - 1525-1497; 0884-8734; 0884-8734
SP - 1238
EP - 1244
EP - 
T1 - Opioid Reduction and Risk Mitigation in VA Primary Care: Outcomes from the Integrated Pain Team Initiative
T2 - Journal of general internal medicine
TI - Opioid Reduction and Risk Mitigation in VA Primary Care: Outcomes from the Integrated Pain Team Initiative
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 31848861
U3 - 10.1007/s11606-019-05572-9
VL - 35
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2020
Y2 - Apr
ER -