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Effect of a Multidisciplinary Review Panel on Daily Morphine Milligram Equivalents for Patients With Chronic Pain
Glenn R Kauppila1, Sarah M Strahm1, Erica L Vogel1
1Mayo Clinic Health System, Northwest Wisconsin Region, Eau Claire, WI, USA.
Introduction/Objective:
Physicians and other health care professionals are challenged regularly to balance managing pain for patients with chronic pain receiving chronic opioid therapy (COT) with following the national guidelines and standards regarding daily morphine milligram equivalents (MME). This quality improvement project aimed to determine the effect of referral to a multidisciplinary review panel on daily MME for patients receiving COT for chronic pain.
Methods:
This quality improvement project included patients who had an established relationship with a primary care or community internal medicine clinician at a large health care organization and were referred to a newly created multidisciplinary review panel for their recommendations regarding treatment of pain. Criteria for patient referral were diagnosis of a chronic, painful condition, and use of chronic opioid medications. These patients were selected and referred at the discretion of their primary care clinician from January 2, 2019, through December 31, 2020. Data for this project were collected at the time of initial referral to the panel and 6 months after recommendations. The daily MME were assessed at the 2 time points.
Results:
Thirteen patients were referred to the review panel during the project period. The median daily MME at the time of referral was 180. Daily MME decreased by a median of 14 MME after 6 months. The MME did not increase during the project period for any participants.
Conclusions:
Referral of patients receiving COT to a multidisciplinary review panel may reduce their daily opioid dose.
Insights
Referral to a multidisciplinary panel may help reduce daily opioid doses for patients on chronic opioid therapy (COT). This quality improvement project observed a median decrease of 14 MME after six months, with no increases for any participants.
Area of Science:
- Pain Management
- Quality Improvement in Healthcare
- Opioid Stewardship
Background:
- Physicians face challenges managing chronic pain with opioid therapy while adhering to national guidelines on morphine milligram equivalents (MME).
- Balancing patient pain management with safe opioid prescribing practices is a critical clinical issue.
Purpose of the Study:
- To evaluate the impact of referring patients on chronic opioid therapy (COT) to a multidisciplinary review panel on their daily MME.
- To assess the effectiveness of a novel quality improvement intervention in managing opioid doses for chronic pain patients.
Main Methods:
- A quality improvement project involving patients with chronic pain on COT referred to a multidisciplinary review panel.
- Data collected at referral and 6 months post-recommendation, focusing on daily MME.
- Patient selection based on chronic painful conditions and opioid use, at clinician discretion.
Main Results:
- Thirteen patients were referred during the study period (January 2019 - December 2020).
- Median daily MME at referral was 180.
- A median decrease of 14 MME was observed at 6 months; no patients experienced an increase in MME.
Conclusions:
- Referral to a multidisciplinary review panel appears to be an effective strategy for reducing daily opioid doses in patients on COT.
- This approach may support adherence to national guidelines for opioid prescribing.
- Multidisciplinary input can aid in optimizing pain management and opioid stewardship.
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