16,000 health care providers to receive updated prescribing reports
As Minnesota health care providers begin to receive updated opioid prescribing reports in the coming days, data from the Department of Human Services shows that prescribing practices are becoming safer, with providers writing fewer prescriptions for opioids and for lower doses when they do prescribe the drugs for pain management.
Almost 16,000 providers serving patients in the Medical Assistance and MinnesotaCare programs will receive individualized reports that compare their opioid prescribing practices to those of anonymous peers and recommended thresholds. Trends tracked by DHS are encouraging, with the number of prescriptions over recommended doses falling in the past several years.
The most dramatic decrease occurred in the number of patients simultaneously prescribed chronic opioid therapy and benzodiazepines, a potentially lethal combination. In 2016, 2,541 public health care program enrollees had prescriptions for both drugs at the same time. That number dropped 57percent to 1,091 enrollees in a one-year period ending in September.
Significant improvement was also seen in these measures:
• 56 percent fewer prescriptions written over recommended doses during the acute and post-acute pain periods
• 51 percent fewer index opioid prescriptions written over recommended doses (an index opioid prescription is one written for someone who hasn’t had an opioid prescription in 90 days)
• 33 percent fewer index opioid prescriptions written
• 54 percent fewer patients receiving doses of chronic opioid therapy that exceed recommendations
“The Minnesota health care community is stepping up to the challenge of managing pain appropriately while keeping patients safe,” Human Services Commissioner Jodi Harpstead said. “Opioids remain an important tool to treat pain, but only when the benefits outweigh the risks.”
DHS aims to build awareness among providers by giving them the information to identify and prevent unsafe prescribing behavior. State law requires DHS to provide the private reports each year and manage a quality improvement program for providers whose reports show they continue to prescribe outside of community standards. The current reports, the second round since the program began in 2019, will give providers updated data before they may be required to participate in a quality improvement program when the next round of reports is released, around the end of 2020.
Because abrupt changes in opioid therapy for patients with chronic pain can be harmful, DHS warns providers to avoid rapid tapering or sudden discontinuation of opioids due to the significant risks of withdrawal, unless a life-threatening issue exists. Prescription opioid therapy remains an important option for patients with severe acute pain or cancer-related pain, and for those receiving hospice care. However, opioids can be addictive after just a few days of use, and growing evidence shows they are unsafe and generally ineffective in managing chronic, non-cancer-related pain.
With health care providers and patients concerned about finding the right balance of opioid use, pain management and patient safety, the state has emphasized the need to work together. DHS held a listening session with chronic pain patients in December to learn more about their experiences with opioid therapy and pain management. In November, health system leaders, the Minnesota Hospital Association, the Minnesota Medical Association, the Institute for Clinical Systems Improvement and DHS met to explore ways to improve patient safety and support providers as they improve their prescribing practices.
The Opioid Prescribing Work Group provides guidance and direction on the Opioid Prescribing Improvement Program. Meetings are public and offer opportunities for comment.
The “Flip the Script” campaign, launched earlier this year, gives providers resources to reframe the conversation about pain management with patients and follow safe prescribing practices. “Flip the Script” resources can be found at https://mn.gov/dhs/opip. Health care professionals can also visit the website for other educational resources, continuing education credits, and email updates on the prescribing reports and quality improvement program.