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ITHS › ITHS Impact › Translational Science Benefits Model Profiles › Six Building Blocks for Improving Opioid Medication Management in Primary Care

Six Building Blocks for Improving Opioid Medication Management in Primary Care

TRANSLATIONAL SCIENCE BENEFITS MODEL PROFILE

The Six Building Blocks team

Benefits

Summary

Fifty million Americans suffer from chronic pain, and 1 in 5 adults with chronic pain use prescription opioids.1,2 Most patients who take opioids for chronic pain are cared for by primary care providers. Long-term opioid therapy increases risk of opioid use disorder and higher dosages increase overdose risk.3 Primary care providers struggle with providing evidence-based care to their patients with chronic pain while reducing the potential for harm from long-term opioid therapy.

six cubes in different colors falling to the ground

Six Building Blocks logo

While studying effective team-based primary care for another project, a team of researchers from the University of Washington Department of Family Medicine and Kaiser Permanente Washington Health Research Institute realized that the successful clinics all had systems in place to manage opioid treatment for patients with chronic pain.4 The team identified six ‘Building Blocks’ to improve opioid prescribing that were common across the clinics: 1) leadership & consensus; 2) policies, agreements & workflows; 3) tracking and monitoring; 4) planned patient-centered visits; 5) resources for complex patients; and 6) measuring success.5

The team recruited six rural-serving organizations with 20 clinics throughout eastern Washington and central Idaho to implement the program supported by a practice facilitator, shared learning calls, and shared resources.6 Each clinic had an improvement team and a clinical champion. After 15 months, fewer patients in Six Building Blocks clinics were on long-term opioid therapy or using higher doses, compared to a control group of patients from the same areas.6 Doctors and staff were also less stressed and more confident in managing patients on long-term opioid therapy.7 Subsequently, the Six Building Blocks program has reached at least 94 clinics and clinical organizations through direct implementation in 50 primary care clinics, training of 40 practice facilitators across 16 organizations to implement the program, and development and testing of a self-service “How-To-Implement Toolkit” in 35 clinics.8

Significance

Caring for the sheer number of patients using opioids places a heavy burden on primary care providers, who already suffer from high rates of burnout.9 The Six Building Blocks program shows that educating individual providers about opioid prescribing is not enough; a team-based approach is important to successfully manage long-term opioid therapy for patients. The Six Building Blocks program offers a new model that can improve quality of care for patients on long-term opioid therapy, reduce provider stress, and result in better outcomes for these patients.6,7 By reducing the use of higher dose opioids and long-term opioid therapy, the Six Building Blocks could reduce the substantial economic cost of opioid use disorder on society (estimated at over $471 billion in 2017).10

The Six Building Blocks program is also promising for managing opioid use in rural areas, which have been among the hardest hit by opioid use. Opioids are prescribed more often in rural communities,11 and rural health care providers often lack the training and resources to adequately care for patients on long-term opioid therapy.12 The original Six Building Blocks study served a rural population, revealing both facilitators and challenges unique to rural settings. Many of the clinics reached through later efforts were either rural locations or safety net community health centers.

Benefits

  • Demonstrated benefits are those that have been observed and are verifiable.
  • Potential benefits are those logically expected with moderate to high confidence.

The Six Building Blocks program materials provide guidance on identification of opioid use disorder and co-occurring medical and mental health conditions that can impede management of chronic pain into standard care.
Demonstrated.

Clinical Benefits:
Diagnostic Procedures

The Six Building Blocks program has been included in guidance on managing patients with chronic pain using long-term opioid therapy from SAMHSA, CDC, the Providers Clinical Support System, and the Washington State Medical Association.13–16
Demonstrated.

Clinical Benefits:
Guidelines

The Six Building Blocks program provides guidance materials on clinical management of long-term opioid use, including patient-centered visits and patient monitoring to identify care gaps.
Demonstrated.

Clinical Benefits:
Therapeutic Procedures

The Six Building Blocks program reduced use of opioid medications by patients with chronic pain and reduced use of higher dose opioids by patients who remained on opioid therapy.6
Demonstrated.

Community Benefits:
Disease Prevention & Reduction

The Six Building Blocks program has reached at least 94 clinics and clinical organizations through direct implementation, training of practice facilitators, and testing a self-service “How-To-Implement Toolkit.”
Demonstrated.

Community Benefits:
Health Care Delivery

The Six Building Blocks program increased use of evidence-based practices for managing patients with chronic pain using long-term opioid therapy, improved clinician and staff confidence, and reduced provider stress.6,7
Demonstrated.

Community Benefits:
Health Care Quality

The Six Building Blocks research team developed a How-To guide for implementation in primary care clinics.8
Demonstrated.

Community Benefits:
Health Education Resources

The Six Building Blocks research team developed a website (www.improvingopioidcare.org) with health education resources to help providers care for patients with chronic pain, including a clinic self-assessment and patient education resources.17
Demonstrated.

Community Benefits:
Health Education Resources

By reducing the use of higher dose opioids and long-term opioid therapy, the Six Building Blocks program could reduce the substantial economic cost of opioid use disorder on society.10
Potential.

Economic Benefits:
Societal & Financial Cost of Illness

Members of the Six Building Blocks research team served as faculty on a national learning collaborative to implement the CDC Opioid Prescribing Guideline and advisory groups regarding opioid prescribing in Washington State.18,19
Demonstrated.

Policy Benefits:
Committee Participation

The Six Building Blocks program was included in a report by the Dr. Robert Bree Collaborative, a group appointed by the Washington state Governor to provide evidence-based recommendations to improve patient care.19
Demonstrated.

Policy Benefits:
Scientific Research Reports

This research has clinical, community, economic, and policy implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.

Research Team

Michael L. Parchman, MD, MPH (primary contact), Senior Investigator
Kaiser Permanente Washington Health Research Institute

Laura-Mae Baldwin, MD, MPH; Brooke Ike, MPH; Katie Osterhage, MMS; Ashley Johnson, MPH; David Tauben, MD; Kari Stephens, PhD
Department of Family Medicine, University of Washington

Community Partners:
Washington, Wyoming, Alaska, Montana, & Idaho (WWAMI) region Practice Research Network; Washington State Department of Health; Olympic Community of Health

Learn More About the Project

Diagnostic Procedures

CLINICAL & MEDICAL BENEFITS
Procedures & Guidelines

Diagnostic procedures

Definition: Methods and techniques performed to diagnose disease, disorders, or conditions. Biological samples such as blood, urine, or saliva are used to detect the presence of bacteria, fungi, or other markers to diagnose a disease, disorder, or condition.

Rationale: Diagnostic procedures that are accurate and reliable make for a more efficient health care system by streamlining treatment and recovery, enhancing the quality of patient care, and reducing health care costs.

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Guidlines

CLINICAL & MEDICAL BENEFITS
Procedures & Guidelines

Guidelines

Definition: Formal recommendations or principles to assist with patient care for specific clinical circumstances. Guidelines are issued by professional organizations, government agencies, and nonprofit organizations (e.g., American Academy of Pediatrics, American Medical Association, World Health Organization, U.S. Preventive Services Task Force).

Rationale: Guidelines promote quality and effectiveness of health care services and procedures. Development of guidelines is based on extensive and systematic review of the literature to provide the evidence to support recommendations. Guidelines can serve as helpful evidence of translational research efforts that translate into improved health care services and procedures.

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Therapeutic Procedures

CLINICAL & MEDICAL BENEFITS
Procedures & Guidelines

Therapeutic Procedures

Definition: Methods and techniques that pertain to interventions, treatment, or prevention of diseases, disorders, or conditions. Therapeutic procedures are performed to improve a diagnosed health concern. They encompass a variety of procedures, ranging from the administration of prescription drugs to surgical procedures to psychotherapy.

Rationale: Therapeutic procedures that improve efficiency and/or efficacy can improve the quality of health care, and reduce long-term costs.

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Disease Prevention & Reduction

COMMUNITY & PUBLIC HEALTH BENEFITS
Health Promotion

Disease Prevention & Reduction

Definition: Resources that enhance health promotion and disease prevention in communities or populations. Disease prevention resources focus on reducing the development and severity of disease, such as vaccination and maternal and child health programs. Health promotion resources focus on empowering people to take control of their own health by increasing healthy behaviors, such as nutrition counseling services or support groups. Other indicators can have implications for disease prevention, including community health services, health education or policies.

Rationale: Disease prevention & reduction advances are created through clinical research, but the methods of that research are instructed by how it will be adapted into the population and practice-based evidence (translational research). Meaningful disease prevention & reduction research is informed by clinical and translational research. For example, a very expensive vaccine that has 100% efficacy rate will not translate into as effective disease prevention and reduction intervention as an inexpensive vaccine with 90% efficacy rate.

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Health Care Delivery

COMMUNITY & PUBLIC HEALTH BENEFITS
Health Care Characteristics

Health Care Delivery

Definition: Improved provision and distribution of health services to a patient population. Delivery systems typically include healthcare providers, insurers, and government regulators. Health care delivery is measured in terms of cost, method of payment, regulation, and quality of care.

Rationale: Effective and efficient mechanisms to deliver health services to a target population require transdisciplinary collaboration and widen the impact of evidence-based medicine and health practices.

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Health Care Quality

COMMUNITY & PUBLIC HEALTH BENEFITS
Health Care Characteristics

Health Care Quality

Definition: Improved general characteristics and quality of the health service or care provided based on accepted standards of quality. Health care quality is measured in terms of effectiveness of care, equity of care to patients with different characteristics, patient experience, complications, unplanned readmissions, and delays in receiving care. Data on these characteristics must be regularly collected to maintain and improve quality.

Rationale: Health care quality informs entire health care systems and is constantly being redefined based on new research and changing patient characteristics. Clinical science uses health care quality to identify strengths and weaknesses of interventions through both qualitative (patient satisfaction) and quantitative (patient remittance rates) measures. Translational science uses health care quality definitions to interpret interventions across different fields with similar health care quality standards.

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Health Education Resources

COMMUNITY & PUBLIC HEALTH BENEFITS
Health Activities & Products

Health Education Resources

Definition: Educational resources that lead to the improvement of health of individuals, populations, or communities. These often take the form of websites, toolkits, and print materials promoting health programs and activities that individuals themselves can do to improve their health, including resources for healthy recipes & active living.

Rationale: Heath education resources serve as potential evidence of knowledge translation to patients and the community. They also serve as preventive strategies that go beyond scientific translation by informing patients and community members of health benefits and risks through audience-targeted delivery and execution.

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Health Education Resources

COMMUNITY & PUBLIC HEALTH BENEFITS
Health Activities & Products

Health Education Resources

Definition: Educational resources that lead to the improvement of health of individuals, populations, or communities. These often take the form of websites, toolkits, and print materials promoting health programs and activities that individuals themselves can do to improve their health, including resources for healthy recipes & active living.

Rationale: Heath education resources serve as potential evidence of knowledge translation to patients and the community. They also serve as preventive strategies that go beyond scientific translation by informing patients and community members of health benefits and risks through audience-targeted delivery and execution.

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Societal & Financial Cost of Illness

ECONOMIC BENEFITS
Financial Savings & Benefits

Societal & Financial Cost of Illness

Definition: Reduced social and economic costs of acute or chronic disease or other health conditions. Examples include general productivity losses, reduced quality of life, and lowered resources.

Rationale: New procedures, interventions, policies, and other benefits from translational science hold the potential to alleviate undue societal and community burden, provide opportunities for reallocation of resources, and increase quality of life.

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Committee Participation

POLICAY & LEGISTLATIVE BENEFITS
Advisory Activities

Committee Participation

Definition: Participation in advisory, standards, or other governmental or nongovernmental committees. Researchers may contribute to a wide range of committees, such as advisory committees, ethics or oversight committees, or topic-specific subcommittees. Participation is often voluntary, but sometimes paid, and can be a significant time commitment in addition to regular scientific activities.

Rationale: Through participation in expert committees, researchers can contribute to recommendations for a range of levels, including operations of institutions, grant funding, device manufacture, and drug regulation.

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Scientific Research Reports

POLICAY & LEGISTLATIVE BENEFITS
Advisory Activities

Scientific Research Reports

Definition: Non-technical, evidence-based documents geared toward audiences who intend to use the information for policy/behavioral change. Target audiences include practitioners, policy makers, public health educators, and the general public. Examples include but are not limited to reports published by the National Institutes of Health, Institute of Medicine, or the Robert Wood Johnson Foundation.

Rationale: Ranging from identification of health problems to intervention evaluation summaries, these documents often provide actionable recommendations based on scientifically-derived findings.

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