What is the purpose?
The purpose of the Opioid Care Processes Change Package is to assist primary care clinics in optimizing processes for paneled patients who use opioids.
What is the aim statement?
By a specific date, the clinic team will have improved their reassessment rate of patients taking opioids by a specific percentage.
What is the outcome measure?
The number of patients with documented reassessment within specific time interval.
What constitutes the balancing measure?
Time to third next available appointment.
What do I need to do before proceeding?
These are the prerequisite change packages that should be reviewed:
Panel Processes Change Package Summary Relational Continuity Change Package SummaryHigh Impact Changes
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Improve the patient experience
Potentially Better Practice
Establish a multidisciplinary quality improvement team and consider including a patient with lived experience
Process Measures
Team meetings are scheduled regularly.Tools
Patient Representative Guide - Opioid
Potentially Better Practice
Test and implement a patient-centred care planning approach.
Process Measures
The number of patients using opioids with a documented care plan in last 12 months.Tools
Care Plan Template with Prompt
Potentially Better Practice
Create a culture that allows for open conversation about opioids.
Process Measures
- Patient survey or interview
- Team survey
Tools
Let's Talk About Opioid Poster -
Identify paneled patients for care improvements
Potentially Better Practice
Generate lists of patients using prescribed opioids.
Process Measures
The number of patients with any opioid prescription.
Tools
EMR Guides - Opioid
Potentially Better Practice
Generate lists of patients using illicit opioids.
Process Measures
The number of patients using illicit opioids
Tools
EMR Guides - Opioid -
Optimize care management and prescribing
Initiating Opioids
Potentially Better Practice
Assess the risk of opioid misuse for patients before initiating opioid therapy.
Process Measures
The number of patients using opioids with completed risk assessment.
Tools
Opioid Risk Tool
Potentially Better Practice
Engage patients in a conversation about the benefits, side effects, and risks prior to prescribing opioids.
Process Measures
The number of patients with a documented opioid pre-prescribing conversation.
Tools
Provider Patient Conversation Checklist - Opioid
Potentially Better Practice
Establish a process where Netcare is reviewed prior to prescribing opioids.
Process Measures
The number of patients with documentation of review in chart.
Tools
Process Mapping
Management of Patients Using Opioids
Potentially Better Practice
Reassess patient taking opioids for changes in functions, pain, side effects, and mental health.
Process Measures
The number of patients overdue for reassessment.
Tools
Brief Pain InventoryMental Health Assessment (e.g. PHQ9, GAD7, ACEs) templates in your clinic's EMR.
Potentially Better Practice
Assess patients for Opioid Use Disorder(OUD)
Process Measures
The number of patients screened for OUD.
Tools
Prescription Opioid Misuse Index (POMI) -
Standardize documentation
Potentially Better Practice
Record all opioid prescriptions in the EMR.
Process Measures
The number of patients with any opioid prescription.
Tools
Process Mapping
Potentially Better Practice
Record illicit opioid use in the EMR.
Process Measures
The number of patients using illicit opioids.
Tools
Process Mapping
Potentially Better Practice
Record offers of Opioid Agonist Therapy (OAT) in the EMR.
Process Measures
The number of document offers of OAT for patients with OUD.
Tools
Measurement Guide - Opioid -
Coordinate care in the medical home
Potentially Better Practice
Establish clear roles and responsibilities and a shared mental model for opioid processes amongst your medical home team.
Process Measures
Team Assessment
Roles and Responsibilities - Opioids Team Assessment - Opioid -
Coordinate care in the health neighbourhood
Potentially Better Practice
Establish processes for coordinating the care of paneled patients using opioids (e.g. specialty and community services, pain, mental health) within your community and zone.
Process Measures
Team Assessment
Who Can Help Framework
Learn@AMA Training
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Opioid Comprehensive Change Package Sequence to Achieve Change Example - Opioid
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