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Evaluation of Health Plan Interventions to Influence Chronic Opioid Therapy Prescribing

Saunders, Kathleen W. JD*; Shortreed, Susan PhD*; Thielke, Stephen MD, MSPH, MA†,‡; Turner, Judith A. PhD†,§,∥; LeResche, Linda ScD; Beck, Randi MD#; Von Korff, Michael ScD*

doi: 10.1097/AJP.0000000000000159
Original Articles

Objectives: Evaluate health plan interventions targeting physician chronic opioid therapy (COT) prescribing.

Materials and Methods: In 2006, Group Health’s (GH) Integrated Group Practice (IGP) initiated diverse interventions targeting COT prescriber norms and practices. In 2010, the IGP implemented a COT guideline, including a mandated online course for physicians managing COT. These interventions were not implemented in GH’s network practices. We compared trends in GH-IGP and network practices for 2006 to 2012 in the percent of patients receiving COT and their opioid dose. We compared physician beliefs before versus after the mandated course and precourse to postcourse changes in COT dosing for IGP physicians who took the course.

Results: From 2006 to 2012, mean (SE) daily opioid dose among IGP COT patients (intervention setting) declined from 74.1 mg (1.9 mg) morphine equivalent dose (MED) to 48.3 mg (1.0 mg) MED. Dose changes among GH network COT patients (control setting) were modest—88.2 mg (5.0 mg) MED in 2006 to 75.7 mg (2.3 mg) MED in 2012. Among physicians taking the mandated course in 2011, we observed precourse to postcourse changes toward more conservative opioid prescribing beliefs. However, COT dosing trends did not change precourse to postcourse.

Discussion: Following initiatives implemented to alter physician prescribing practices and norms, mean opioid dose prescribed to COT patients declined more in intervention than control practices. Physicians reported more conservative beliefs regarding opioid prescribing immediately after completing an online course in 2011, but the course was not associated with additional reductions in mean daily opioid dose prescribed by physicians completing the course.

*Group Health Research Institute

Departments of Psychiatry and Behavioral Sciences

§Rehabilitation Medicine

Anesthesiology and Pain Medicine

Oral Medicine, University of Washington

Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center

#Department of Physical Medicine and Rehabilitation, Group Health, Seattle, WA

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Supported by grants from the National Institute on Aging (AG034181, M.V.K.) Bethesda, MD, and from the Patient-Centered Outcomes Research Institute , Washington D.C., (R-IHS-1306-02198, M.V.K.). The Group Health Foundation (Seattle, WA) provided funding for modifications made to the online CME program that was originally developed by the Department of Veterans Affairs. K.W.S. owns stock in Merck. S.S. has received funding from research grants awarded to Group Health Research Institute (GHRI) by Bristol-Myers Squibb. M.V.K. is the Principal Investigator of grants to GHRI from Pfizer Inc. that concern opioids. These grants also support K.W.S. M.V.K. was the Principal Investigator of a grant to GHRI from Johnson & Johnson concerning prediction of clinical pain outcomes. This grant also supported K.W.S., J.A.T., and L.L. M.V.K. is Vice President of Physicians for Responsible Opioid Prescribing (PROP), an organization that has advocated for more cautious and selective prescribing of opioids for chronic pain. He has received no compensation or reimbursement for travel (etc.) expenses for his work with PROP. The remaining authors declare no conflict of interest.

Reprints: Kathleen W. Saunders, JD, Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101 (e-mail:

Received February 25, 2014

Received in revised form February 9, 2015

Accepted August 31, 2014

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