Presented at the 2012 AAPM Annual Meeting « Back

Utilization of a State Prescription Monitoring Program for Quality and Safety Improvement for Pain Management in an Outpatient Palliative Care Setting

J. Cameron Muir, MD, cmuir@capitalcaring.org¹, Heidi Young, MD¹, Aaron M. Gilson, MS MSSW PhD², Carl Scheffey¹, Malene Davis, MBA MSN RN¹, Perry G. Fine, MD³, Stephen R. Connor, PhD¹ (1) Capital Caring, Falls Church, Virginia, (2) University of Wisconsin Carbone Cancer Center, Madison, Wisconsin (3) University of Utah, Salt Lake City, Utah

Background: The utility of electronic prescription monitoring programs (PMP) has not been well-studied. Clinical benefits of PMPs, although intuitively sensible, have not been established. We describe the use of a PMP in an outpatient specialty palliative care (PC) setting to evaluate both quality and safety benefits. Methods: Retrospective review of PMP and clinical records of all palliative care outpatient consultations performed in a 12-month period (N = 65). The study involved data encompassing a 6-month period for each PC consultation—3 months pre consultation and 3 months post. Data extraction was performed for all opioid prescriptions dispensed, using a state-based electronic data registry, during the study period as well as the number of prescribing physicians. In addition, the clinical impact of pain relief associated with consultation was extracted from the clinical record as documented by patient self report at each clinical visit using the Edmonton Symptom Assessment System (ESAS). Results: There were both potential quality and safety outcomes that can be inferred from the collected data. From the PMP, palliative care consultation was associated with a) a reduction of 1 physician involved in opioid prescribing (decrease 1.01); b) an increase in the use of long acting opioid formulations (p<0.0004) with c) a concomitant decrease in daily acetaminophen dosing (p = 0.0258). The impact of these interventions on pain outcomes will also be addressed in the presentation. Conclusion: The use of PMP data, in conjunction with systematic documentation of pain scores in clinical practice is associated with both quality and safety outcomes in pain management among outpatient palliative care patients.

Funding: None