Opioid Renewal Clinic: A Multidisciplinary Approach to Opioid Therapy in Chronic Pain Patients at Risk for Substance Abuse

2.50
Hdl Handle:
http://hdl.handle.net/10755/163271
Category:
Abstract
Type:
Presentation
Title:
Opioid Renewal Clinic: A Multidisciplinary Approach to Opioid Therapy in Chronic Pain Patients at Risk for Substance Abuse
Author(s):
Wiedemer, Nancy L.; Harden, Paul S.; Gallagher, Rollin M.; Arndt, Robin O.
Author Details:
Nancy L. Wiedemer, RN, MSN, CRNP, Pain Management Coordinator, Pain Service, Philadelphia, Pennsylvania, USA, email: nancy.wiedemer@med.va.gov; Paul S. Harden; Rollin M. Gallagher; Robin O. Arndt
Abstract:
Purpose: Evidence grows for efficacy of opioids in chronic pain disorders. Guidelines and consensus statements are available to guide practice. Yet primary care practitioners (PCPs), who care for the majority of these patients, are reluctant to prescribe opioids because of concern about diversion, abuse, addiction and regulatory scrutiny, particularly in patients at high risk for addiction disorders. Thus, cost-effective strategies are needed to support PCPs' management of these patients. We describe the development and outcomes of a Nurse Practitioner and Pharm.D managed Opioid Renewal Clinic (ORC) designed to support the primary care management of chronic pain in a high addiction risk population. Theoretical Framework: Translational design- applying published guidelines to clinical practice. Methods (Design, Sample, Setting, Measures, Analysis): PCPs referred patients with chronic pain to the ORC for co-management of opioid therapy. The ORC was developed by a NP, Pharmacist and addictionologist with PCP input. The ORC protocol, developed from guidelines, included the following strategies: opioid treatment agreement (OTA), random urine screens, frequent visits, telephone contacts. Outcome measures included: patient adherence to OTA, rates of use of the OTA and urine drug testing by PCPs, and PCP satisfaction. Results: Out of 335 referred patients, 171(51%) were referred for aberrant drug taking behaviors. In this subgroup, 77 (45%) were able to adhere to the OTA and program; 65 (38%) self -discharged when the structured program was offered; 22 (13%) were referred for addiction treatment; and 7(4%) were weaned from opioids due to consistently negative urine drug tests. 164 patients were referred due to history of substance abuse or for opioid rotation/titration. This group consistently adhered to the OTA. PCPs reported increased confidence and satisfaction in caring for these patients. Conclusions and Implications: The data demonstrate that the structured intervention based on published guidelines improved pain management of these complex patients, allowing for pain management and/or addiction treatment.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2006
Conference Name:
18th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
Cherry Hill, New Jersey
Description:
�New Momentum for Nursing Research: Multidisciplinary Alliances�, held on April 20th -22nd at the Hilton in Cherry Hill, New Jersey
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleOpioid Renewal Clinic: A Multidisciplinary Approach to Opioid Therapy in Chronic Pain Patients at Risk for Substance Abuseen_GB
dc.contributor.authorWiedemer, Nancy L.en_US
dc.contributor.authorHarden, Paul S.en_US
dc.contributor.authorGallagher, Rollin M.en_US
dc.contributor.authorArndt, Robin O.en_US
dc.author.detailsNancy L. Wiedemer, RN, MSN, CRNP, Pain Management Coordinator, Pain Service, Philadelphia, Pennsylvania, USA, email: nancy.wiedemer@med.va.gov; Paul S. Harden; Rollin M. Gallagher; Robin O. Arndten_US
dc.identifier.urihttp://hdl.handle.net/10755/163271-
dc.description.abstractPurpose: Evidence grows for efficacy of opioids in chronic pain disorders. Guidelines and consensus statements are available to guide practice. Yet primary care practitioners (PCPs), who care for the majority of these patients, are reluctant to prescribe opioids because of concern about diversion, abuse, addiction and regulatory scrutiny, particularly in patients at high risk for addiction disorders. Thus, cost-effective strategies are needed to support PCPs' management of these patients. We describe the development and outcomes of a Nurse Practitioner and Pharm.D managed Opioid Renewal Clinic (ORC) designed to support the primary care management of chronic pain in a high addiction risk population. Theoretical Framework: Translational design- applying published guidelines to clinical practice. Methods (Design, Sample, Setting, Measures, Analysis): PCPs referred patients with chronic pain to the ORC for co-management of opioid therapy. The ORC was developed by a NP, Pharmacist and addictionologist with PCP input. The ORC protocol, developed from guidelines, included the following strategies: opioid treatment agreement (OTA), random urine screens, frequent visits, telephone contacts. Outcome measures included: patient adherence to OTA, rates of use of the OTA and urine drug testing by PCPs, and PCP satisfaction. Results: Out of 335 referred patients, 171(51%) were referred for aberrant drug taking behaviors. In this subgroup, 77 (45%) were able to adhere to the OTA and program; 65 (38%) self -discharged when the structured program was offered; 22 (13%) were referred for addiction treatment; and 7(4%) were weaned from opioids due to consistently negative urine drug tests. 164 patients were referred due to history of substance abuse or for opioid rotation/titration. This group consistently adhered to the OTA. PCPs reported increased confidence and satisfaction in caring for these patients. Conclusions and Implications: The data demonstrate that the structured intervention based on published guidelines improved pain management of these complex patients, allowing for pain management and/or addiction treatment.en_GB
dc.date.available2011-10-27T11:04:28Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:04:28Z-
dc.conference.date2006en_US
dc.conference.name18th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationCherry Hill, New Jerseyen_US
dc.description�New Momentum for Nursing Research: Multidisciplinary Alliances�, held on April 20th -22nd at the Hilton in Cherry Hill, New Jerseyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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