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Opioid Management in Older Adults: Lessons Learned From a Geriatric Patient-Centered Medical Home
Nkechi Azubike1, Michelle Moseley1, James S Powers1
1is an Advanced Practice Nurse, is a Clinical Pharmacist, and is the Clinical Associate Director at the Geriatric Research Education and Clinical Center, all at the Tennessee Valley Healthcare System. James Powers is a Geriatrician at the Vanderbilt Center for Quality Aging in Nashville.
Summary
Managing older adults with chronic prescription opioid therapy in a patient-centered medical home can be effective. An interdisciplinary team approach is crucial for optimizing care and improving health outcomes for this complex population.
Area of Science:
- Geriatrics
- Pain Management
- Public Health
Background:
- The opioid crisis significantly impacts older adults, posing challenges for implementing best practices in prescription opioid management.
- This study examines the management of high-risk older patients receiving chronic opioid therapy within a US Department of Veterans Affairs (VA) patient-centered medical home (PCMH).
Purpose of the Study:
- To evaluate the effectiveness of guideline-based, PCMH management for older adults on chronic prescription opioid therapy.
- To assess the health and well-being outcomes in this patient group over a 1-year period.
Main Methods:
- A retrospective chart review and operations data analysis of 48 high-risk older patients (mean age 70.4 years) receiving chronic opioid therapy.
- Utilized VA electronic health records, including the patient portal and telemedicine capabilities, within the GeriPACT program.
Main Results:
- Patients frequently had comorbidities (diabetes, heart failure, dementia) and chronic kidney disease (eGFR < 60 mL/min).
- High rates of prior emergency department visits and hospitalizations for opioid-related issues were noted.
- Interventions included dose reductions for benzodiazepines/narcotics; some patients experienced accidental overdoses or had positive urine drug screens.
Conclusions:
- Guideline-based PCMH management is an effective model for improving the health and well-being of older adults with chronic pain on opioid therapy.
- An interdisciplinary team approach is essential for managing complex older patients on chronic opioid treatment.
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