Opioid addiction in Massachusetts has become a serious problem with more than 1,000 residents dying of opioid overdoses in 2014. At the same time, pain management is an essential part of every medical practice, requiring clinicians and care teams to carefully consider the best treatment for patients who are suffering. Opioid medications can play an important role in managing pain, though misuse or abuse of opioids can also lead to significant patient and societal consequences.
Physicians in Massachusetts recognize this growing crisis and are taking important steps to reduce the abuse of opioids across the state. The Massachusetts Medical Society recently launched a campaign calling upon prescribers and the public to make educated decisions about the safe and responsible prescribing of these medications. In addition, the state established a 16-member Opioid Addiction Working Group tasked with formulating a statewide strategy to combat addiction, which released its report yesterday. We applaud the attention to this important issue and are committed to creating a culture at Atrius Health in which clinicians and staff can safely prescribe opioids and monitor patients who need opioids to manage chronic pain.
At Atrius Health, we have taken several steps to improve the safety of patients who receive opioids. Clinicians have easy access to tools in the electronic health record (EHR) that can help predict whether patients will take an opioid medication appropriately. Factors such as age, previous histories of substance abuse, and family history help clinicians gauge if a patient might be at risk for addiction. We’ve also built other educational resources into our EHR, such as tools to help clinicians interpret urine drug screens.
For patients who receive more than 60 days of continual opioid therapy, Atrius Health has adopted guidelines that require patients to sign an Opioid Treatment Agreement. The agreement explains proper use of the medication, what kind of monitoring patients can expect while on the medication, and the consequences of violating the agreement. Patients are required to have a urine toxicology screening at the beginning of their therapy and then at least once per year thereafter.
Our clinicians are also encouraged to use the Massachusetts Online Prescription Monitoring Program (PMP), which provides information on a patient’s controlled substance prescription history over the last 12 months. This secure website, run by the Massachusetts Department of Public Health (DPH), helps doctors monitor whether patients may be abusing opioids. Atrius Health was also involved in the DPH workgroup that addressed policies on how physicians can designate delegates to use the PMP in order to improve workflow and make it a more practical tool for physicians. Read more about our involvement with the PMP regulations in this previous blog post. Atrius Health is also working with the DPH to develop a direct interface with the PMP in our EHR that would allow doctors to quickly access the PMP without disrupting their normal workflow.
In addition to working with our clinicians, we have also made efforts to engage other members of the care team to support treating patients on Chronic Opioid Therapy. When patients are due for prescription refills, our refill coordinators help keep track of whether a patient has had a urine drug screen or has a treatment agreement on file. If a patient is overdue for a urine drug screen or doesn’t have a treatment agreement, we have developed standard work for the refill coordinators to remind the doctors to make sure these elements are in place. This has led to major performance improvements in our management of these patients.
By adopting opioid guidelines, tracking data on performance, educating our clinical care team, and communicating with patients, Atrius Health is changing its culture to effectively manage chronic pain and opioid prescriptions for our patients in order to prevent unnecessary addiction.
Dr. Thomas Isaac is an internist at Harvard Vanguard Medical Associates and the Medical Director of Clinical Variation and Quality Standards in the Quality and Safety Department. He has worked at Atrius Health since July 2012, collaborating with senior leadership on a wide range of quality and clinical variation initiatives. He is the chair of the Atrius Guideline Committee and helped create, implement, and monitor standards for patients on chronic opioid therapy at Atrius Health.
Dr. Isaac did his residency at Thomas Jefferson Medical School in Philadelphia PA. He was part of a joint MD/MBA program, receiving his MBA from Widener University in Chester, PA. He completed his Internal Medicine residency at Rhode Island Hospital in Providence, RI and also completed his chief residency there. He completed a General Internal Medicine fellowship at Harvard and received his MPH from the Harvard School of Public Health. He worked at Beth Israel Deaconess for 4 years as an outpatient primary care doctor, and was also involved in QI work and research. He was the first Lucian Leape Institute Fellow (affiliated with the NPSF), where he worked closely with leaders in the field of quality and safety. His research has examined quality and safety indicators, medication drug alerts, and patient-doctor communication.
Dr. Richard Lopez, a physician at Harvard Vanguard Medical Associates, was appointed Chief Medical Officer of Atrius Health in January 2009. In this position, Dr. Lopez works collaboratively with senior clinical and executive leadership across a wide range of clinical and quality initiatives. Specifically, Dr. Lopez’s focus includes clinical program development relating to population health, clinical aspects of payer/hospital contracting, clinical informatics, medical management, and safety and quality, as well as collaborating to develop quality standards and the outcome reporting measures and clinical dashboards that support the Atrius Health practices meeting those standards. More than a 30-year veteran of Harvard Vanguard, Dr. Lopez has made many significant contributions to the organization and is the recipient of Harvard Vanguard’s Lifetime Achievement Award. He also received the Becker Healthcare Leadership Award in 2014. Dr. Lopez received his medical degree from Boston University School of Medicine and completed his residency and internship at St. Elizabeth’s Hospital. Dr. Lopez received his Bachelor of Arts degree from Boston University . As a board certified internist, Dr. Lopez has practiced primary care internal medicine at Harvard Vanguard’s Medford practice since 1982. Dr. Lopez serves on the Board of the Risk Management Foundation and several committees including Vice Chair of the Massachusetts Medical Society Committee on Quality of Medical Practice and the Massachusetts Statewide Quality Advisory Committee.