Multimodal Local Opioid Prescribing Intervention Outcomes in Chronic Noncancer Pain Management

J Am Board Fam Med. 2019 Jul-Aug;32(4):559-566. doi: 10.3122/jabfm.2019.04.180296.


Background: Opioid misuse in the United States has made it challenging for physicians to treat chronic noncancer pain (CNCP). We implemented an educational program aimed at promoting safe opioid prescribing practices in hopes of increasing the level of appropriateness associated with prescribing opioids for CNCP.

Methods: We conducted a quality-improvement study with a retrospective chart review of adult patients who were prescribed opioids for CNCP for at least 90 consecutive days at 2 academic primary care clinics. Patients were reviewed at baseline (July 2014-May 2015) and after initial interventions (January 2016-June 2016; ie, following multimodal educational activities on appropriate opioid prescription implemented from June 2015-December 2015). An opioid appropriateness score was calculated based on documentation of 9 items. Categorical variables were analyzed with Fisher exact tests and continuous variables by 2-sample t tests and regression analysis. Binary logistic regression was used for multivariable modeling. Mann-Whitney test was used to compare appropriateness scores before and after intervention.

Results: A total of 177 and 96 patients were evaluated at baseline and postintervention, respectively. Patient demographic characteristics were not statistically different. Overall, postintervention level of appropriateness was significantly different from preintervention (P < .0001), with means increasing from 5.54 preintervention to 6.29 postintervention. Both clinics had significant improvement from baseline (both P values <.003).

Conclusions: Clinician education on best practices while treating CNCP is associated with an increase in the level of opioid use appropriateness.

Keywords: Chronic Pain Management; Family Physicians; Logistic Models; Opioid Analgesics; Opioid-Related Disorders; Patient Safety; Primary Health Care; Quality Improvement; Retrospective Studies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Attitude of Health Personnel
  • Chronic Pain / drug therapy*
  • Clinical Competence
  • Drug Prescriptions / standards
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Humans
  • Inappropriate Prescribing / prevention & control
  • Inappropriate Prescribing / statistics & numerical data
  • Male
  • Middle Aged
  • Opioid Epidemic / prevention & control
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / etiology
  • Opioid-Related Disorders / prevention & control
  • Pain Management / adverse effects
  • Pain Management / standards
  • Pain Management / statistics & numerical data
  • Physicians, Primary Care / education
  • Physicians, Primary Care / standards
  • Physicians, Primary Care / statistics & numerical data*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / organization & administration*
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data
  • Primary Health Care / organization & administration*
  • Primary Health Care / standards
  • Primary Health Care / statistics & numerical data
  • Program Evaluation
  • Quality Improvement
  • Retrospective Studies
  • United States / epidemiology


  • Analgesics, Opioid