TY - JOUR
T1 - Factors that impact initiation of pain management agreements for patients on chronic opioid therapy
AU - Gonzalez, Katherine
AU - Villasante-Tezanos, Alejandro
AU - Sharma, Gulshan
AU - Doulatram, Gulshan
AU - Williams, Stephen B.
AU - Hommel, Erin L.
N1 - Publisher Copyright:
© 2023 Journal of Opioid Management.
PY - 2023/10
Y1 - 2023/10
N2 - Objective: This analysis seeks to understand variables within our institution that impact pain management agreement (PMA) utilization for chronic noncancer pain (CNCP). Design: Retrospective chart review. Setting: Public academic medical center. Patients: Adults prescribed an opioid for CNCP between July 2020 and October 2020. Main outcome measure: We assessed the association between patient demographics, prescription factors, and prescriber factors with the presence of a PMA. Unadjusted rates and chi-square tests were generated for each predictor. Additionally, we performed two multivariable logistic regressions: one including all variables and another utilizing a stepwise forward variable selection process to further understand the relationships between predictors and the presence of a PMA. Results: 49.7 percent of patients who received an opioid for CNCP had a PMA on file. One significant predictor of the presence of PMA was prescriber specialty with anesthesia/pain medicine, demonstrating 88 percent compliance. Compared to anesthesia/pain medicine, patients receiving opioids from internal medicine had an odds ratio (OR) of 0.155 (95 percent confidence interval (CI), 0.109-0.220), while patients receiving opioids from family medicine had an OR of 0.122 (95 percent CI, 0.090-0.167). Additionally, patients who received schedule II opioids (as opposed to schedule III/IV opioids), patients with multiple opioid fills in 3 months, middle aged patients, and Black patients were more likely to have a PMA. Conclusions: Compliance with PMA within our institution was only 49 percent despite an existing state law mandating use. Our analysis suggests quality improvement interventions should target patients on schedule III/IV opioids who receive their prescriptions from primary care providers.
AB - Objective: This analysis seeks to understand variables within our institution that impact pain management agreement (PMA) utilization for chronic noncancer pain (CNCP). Design: Retrospective chart review. Setting: Public academic medical center. Patients: Adults prescribed an opioid for CNCP between July 2020 and October 2020. Main outcome measure: We assessed the association between patient demographics, prescription factors, and prescriber factors with the presence of a PMA. Unadjusted rates and chi-square tests were generated for each predictor. Additionally, we performed two multivariable logistic regressions: one including all variables and another utilizing a stepwise forward variable selection process to further understand the relationships between predictors and the presence of a PMA. Results: 49.7 percent of patients who received an opioid for CNCP had a PMA on file. One significant predictor of the presence of PMA was prescriber specialty with anesthesia/pain medicine, demonstrating 88 percent compliance. Compared to anesthesia/pain medicine, patients receiving opioids from internal medicine had an odds ratio (OR) of 0.155 (95 percent confidence interval (CI), 0.109-0.220), while patients receiving opioids from family medicine had an OR of 0.122 (95 percent CI, 0.090-0.167). Additionally, patients who received schedule II opioids (as opposed to schedule III/IV opioids), patients with multiple opioid fills in 3 months, middle aged patients, and Black patients were more likely to have a PMA. Conclusions: Compliance with PMA within our institution was only 49 percent despite an existing state law mandating use. Our analysis suggests quality improvement interventions should target patients on schedule III/IV opioids who receive their prescriptions from primary care providers.
KW - chronic pain
KW - opioid therapy
KW - pain management agreement
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U2 - 10.5055/jom.0816
DO - 10.5055/jom.0816
M3 - Article
C2 - 37968976
AN - SCOPUS:85177103379
SN - 1551-7489
VL - 19
SP - 423
EP - 431
JO - Journal of Opioid Management
JF - Journal of Opioid Management
IS - 5
ER -