Multidisciplinary eConsults to Optimize Safe Opioid Prescribing: A Pilot Program

Managing chronic pain is challenging for primary care physicians (PCPs). Sixty percent do not feel confident in pain management skills, which negatively impacts patients. We developed a multidisciplinary electronic consult (eConsult) program that integrates primary care, psychiatry, and pharmacy to guide safe, evidence-based long-term opioid therapy (LTOT). Patients were referred by their care team or identified via chart review as being on LTOT. The E-consult team was comprised of two PCPs, one consult-liaison psychiatrist, and three pharmacists, as well as rotating trainees in the three specialties (internal medicine, psychiatry, and pharmacy). eConsults reviewed medical and psychiatric histories and treatments to recommend additional testing and evidence-based management. Follow-up chart reviews at 3, 6, and 12 months evaluated changes in oral morphine equivalents (OME) and follow-through on recommendations. There was a statistically significant reduction in OME for all populations at 12 months compared to baseline, as well as when psychiatric recommendations were followed versus not followed. eConsults are a unique approach to a growing population of patients with complex chronic pain that allow PCPs access to a multidisciplinary team with expertise.