The Medicare population has one of the highest and fastest growing rates of opioid use disorder, with six out of every 1,000 beneficiaries diagnosed. Additionally, adults age 65 and over in Oregon are hospitalized for opioid-related causes at a rate of nearly 600 per 100,000. This is higher than in any other state in the country and higher than any other age group in Oregon.
With this in mind, HealthInsight, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Nevada, New Mexico, Oregon and Utah, designed its two-year Centers for Medicare & Medicaid Services (CMS) Special Innovation Project (SIP) to empower Oregon-based primary care providers and staff to use evidence-based, patient-centered approaches to chronic pain management, with particular emphasis on older adult care.
The SIP team consulted with local and national advisors, as well as geriatric experts, caretakers and patients, to learn more about current training, beliefs and experiences of physicians and patients navigating chronic pain management. The team discovered that while providers were being inundated with opioid safety recommendations and policies, very little support was being provided for patient-provider communication under challenging situations, screening and referral of patients with opioid use disorder, and nonpharmacological pain management in rural areas.
Since October 2018, the learning management system has averaged 21 unique pageviews per day, and the training has improved provider knowledge across four topic areas by an average of 30 percent.
Thus, the Resources Encouraging Lifestyle Interventions and Enhanced pain treatment for 55+ (RELIEF+) toolkit was born, providing a series of primary care-focused video training modules exploring these topics. The eight modules feature national and local experts on pain management and opioid safety best practices, including Roger Chou, MD, co-author of the Centers for Disease Control and Prevention guidelines for opioid prescribing; Dennis Turk, PhD, author of over 400 publications on chronic pain management and cognitive-behavioral therapy for chronic pain; and Nora Stern, MS, MSPT, program manager for the Persistent Pain Program at Providence Rehabilitation Services.
Between October 2017 and September 2018, the RELIEF+ toolkit was piloted in 50 rural clinics across Oregon, half of which received technical assistance and tailored data reports. During the pilot, rural providers faced barriers in accessing the online resources, such as poor Internet service and lack of comfort with an online platform. In response, the team delivered laminated copies of all RELIEF+ recommended screening tools, resources and workflows to all target clinics. This activity strengthened intervention impact substantially and even increased web activity by 143 percent.
Pilot results revealed the majority of targeted counties experiencing a downward trend in opioid-related hospitalizations, as well as a reduction in prescriptions involving an overlapping opioid and benzodiazepine within older cohorts, which is a strong risk factor for dementia-like symptoms and falls in adults over 65. Since October 2018, the learning management system has averaged 21 unique pageviews per day, and the training has improved provider knowledge across four topic areas by an average of 30 percent.
After the intervention period ends in March 2019, HealthInsight will work with Oregon Health Authority, Oregon Pain Guidance and Oregon Health & Science University to disseminate the RELIEF+ intervention statewide. The SIP team is also presenting the toolkit and outcomes at the Oregon Conference on Opioids & Other Drugs, Pain & Addiction Treatment in May 2019.