Novel peer review method for improving controlled substance prescribing in primary care

Area of Science:

• Primary Care
• Quality Improvement
• Pain Management

Background:

• Opioid prescribing for chronic noncancer pain presents challenges in outpatient settings.
• Urban safety-net teaching hospitals face unique demands in managing pain and prescribing controlled substances.

Purpose of the Study:

• To evaluate the impact of a chart review tool (CRT) providing peer feedback on opioid prescribing practices.
• To assess opioid prescribing patterns in an urban family medicine clinic.

Main Methods:

• A 1-year quality improvement project was conducted in an outpatient family medicine clinic.
• A CRT was implemented for physicians to provide peer feedback on opioid prescribing.
• Physician opioid prescribing practices were compared pre- and post-intervention.

Main Results:

• Sixty percent of reviewed patient charts showed policy violations, often linked to missed specialist appointments.
• The mean opioid dose decreased by 2.6 mg morphine equivalent dose (MED)/day post-intervention, contrasting a prior increase of 6.9 mg MED/day.
• Sixteen percent of patients prescribed opioids were successfully taken off the medication.

Conclusions:

• Implementing a CRT for peer feedback offers valuable insights into opioid prescribing.
• This approach shows promise for enhancing the quality of opioid prescribing in urban primary care settings.