Background: This study examined how different types of support for 32 primary care clinics affected opioid prescribing and overall costs using a 2 x 2 design. Clinics were divided into four groups: education about opioid prescribing and regular feedback on their prescribing patterns only; education and feedback plus help changing clinic workflows; education and feedback plus coaching for prescribers; or education and feedback plus both clinic workflow support and prescriber coaching. The researchers compared changes in average opioid dose, testing and screening practices, and total costs, including costs related to changes in health care use.
What They Found: Clinics that received both clinic workflow support and prescriber coaching had the largest reduction in average opioid dose. Clinics that received clinic workflow support (with or without prescriber coaching) increased screening for pain and daily functioning more than other clinics. Clinics that received education alone showed the largest increases in urine drug testing, treatment agreements, and depression screening. Education alone cost less upfront, but was associated with more expensive urine drug testing, making it the most costly approach overall.
Implications: Among the four approaches, education plus clinic workflow support had the lowest overall cost, largely because it limited increases in urine drug testing and treatment agreements, which were major cost drivers. Education plus clinic workflow support and prescriber coaching led to the largest reductions in average opioid dose.
Andrew Quanbeck, PhD, et al
Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
