PDO Publications Spotlight: Valuing Patient Experience While Addressing the Prescription Opioid Epidemic

CDC Injury Center wants to share recent publications related to prescription opioids and newly available resources.

Publications

Valuing Patient Experience While Addressing the Prescription Opioid Epidemic
A Special Contribution from the Centers for Medicare and Medicaid Services: Valuing Patient Experience While Addressing the Prescription Opioid Epidemic - Annals of Emergency Medicine

The lack of evidence linking patient satisfaction surveys to increased opioid prescribing was noted in an editorial in the Annals of Emergency Medicinepublished online on July 19. In the article, Valuing Patient Experience While Addressing the Prescription Opioid Epidemic, the authors report on a review of the literature examining the relationship between opioid prescribing and scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a hospital patient satisfaction survey. HCAPHS scores are incorporated into the Hospital Value-Based Purchasing (HVBP) program and a portion of payments to hospitals are tied to performance on the quality and cost measures in that program. While the survey was designed for hospital-to-hospital comparisons, there is concern that questions on pain management encourage individual providers to prescribe opioids for pain management.

Looking at the literature, the authors note that there was no notable increase in opioid prescribing in 2006, when HCAHPS was implemented, nor in 2008, when hospital scores began to be reported. Likewise, they point to a review of the research on patient experience by the Department of Health and Human Services, which was only able to identify three adequately designed and peer reviewed studies of the relationship between opioid prescribing and HCAHPS scores in the inpatient setting. The studies consistently found:

• Opioid prescribing was not associated with higher patient experience or satisfaction scores, >
• In some cases, receipt of opioid analgesics in the inpatient setting was associated with a higher likelihood of reporting a poor care experience, and
• The factors most strongly associated with higher patient experience scores are nursing and clinician courtesy and communication.

The Centers for Medicare and Medicaid Services (CMS) is in the process of reviewing the HCAHPS pain questions and conducting further research to better understand whether and in what ways quality measures incorporating patient feedback influence clinical prescribing behavior.

Public Health Detailing – A Successful Strategy to Promote Judicious Opioid Analgesic Prescribing

Academic detailing – one-on-one educational visits with providers – is a strategy for bringing opioid prescribing in line with current recommendations. In this article published in the American Journal of Public Health, the authors describe a study in Staten Island, NY that identified a positive association between academic detailing and improvements in provider knowledge about opioid prescribing recommendations. The detailing initiative was also associated with a decrease in the rate of high-dose prescribing. Other jurisdictions could consider implementing a public health detailing campaign to encourage prescribing that is consistent with guidelines.

Trends in Methadone Sales for Pain Treatment, Diversion, and Overdose Deaths, United States, 2002-2014

The prescription opioid methadone used for pain has been identified as an important contributor to the rise in opioid-related overdose deaths. Starting in 2006, Federal and state actions to reduce the use of methadone for pain were intensified, and a new study published in the July 7 Morbidity and Mortality Weekly Report (MMWR) evaluates the association between these efforts and rates of methadone sales, diversion, and overdose deaths between 2002 and 2014. The authors concluded that additional clinical and public health policy changes are needed to further reduce the harm associated with methadone when prescribed as a pain treatment.

Resources and Materials

CDC has also made available new prescription opioid prevention materials and training opportunities, including:

• Prescription Opioids What You Need to Know(fact sheet)
  This is fact sheet provides information on the risks of opioid medications and on what other options are available for pain management following a surgery or injury
• CDC Guideline for Prescribing Opioids for Chronic Pain (infographic)
  This infographic illustrates the scope of the epidemic of opioid abuse and overdose, notes alternative ways to manage chronic pain, and gives a brief overview of the CDC Guideline for Prescribing Opioids for Chronic Pain.
• COCA Call Webinar Series (training)
  This webinar series addresses when and how opioids should be initiated for chronic pain, how to assess risk and address harms of opioid use, and when and how opioids should be discontinued. Faculty and clinicians from the University of Washington also provide insight into the application of the CDC Guideline in clinical settings.

Learn More

For more information on prescription opioid overdose visit: http://www.cdc.gov/drugoverdose/index.html