Opioid Therapy Practiceand Policy Issues
National Opioid Pain Care Agreementand Large Quantity Opioid Prescription
Review
Opioid Therapy Practiceand Policy Issues
National Opioid Pain Care Agreementand Large Quantity Opioid Prescription
Review
Francine Goodman, Pharm.D., BCPSClinical Pharmacy Specialist, National PBM ServicesProject Leader, National Opioid Pain Care Agreement
Francine Goodman, Pharm.D., BCPSClinical Pharmacy Specialist, National PBM ServicesProject Leader, National Opioid Pain Care Agreement
National Opioid Pain Care Agreement
Three Documents
National Opioid Pain Care Agreement
Three DocumentsDIRECTIVEDIRECTIVE
Supports • a standard, national
Opioid Pain Care Agreement
• a single location (Clinical Warnings / CWAD) in VHA’s Computerized Patient Record System (CPRS)
Supports • a standard, national
Opioid Pain Care Agreement
• a single location (Clinical Warnings / CWAD) in VHA’s Computerized Patient Record System (CPRS)
THE OPCATHE OPCA
Available via iMedConsentTM program
PATIENT INFORMATIONSupplements the OPCA
Available via iMedConsentTM program
PATIENT INFORMATIONSupplements the OPCA
TO DO LISTTO DO LIST
Form work groupObtain field inputCombine opioid
agreementsDistill core OPCA
Form work groupObtain field inputCombine opioid
agreementsDistill core OPCA
TO DO LISTTO DO LIST
Improve readability
Pilot in patientsBuild consensus
(ongoing)
Improve readability
Pilot in patientsBuild consensus
(ongoing)
FINAL TO DO’SFINAL TO DO’S(FY10)
Submit to VACO for concurrence
Post Model OPCA on VHA Pain Management Web sitehttp://www1.va.gov/pain_management/index.cfm
Provider Education
(FY10)Submit to VACO
for concurrencePost Model OPCA
on VHA Pain Management Web sitehttp://www1.va.gov/pain_management/index.cfm
Provider Education
STILL UNDER
CONSTRUCTION
THANK YOU FOR YOUR PATIENCE
Large Quantity Opioid Rx Reviews
Large Quantity Opioid Rx Reviews
•Goal–To evaluate appropriateness (quality and safety) of aberrant large-quantity opioid prescriptions
•Extends Multi-site and Multi-VISN Opioid / CN101 Rx Reviews
•Goal–To evaluate appropriateness (quality and safety) of aberrant large-quantity opioid prescriptions
•Extends Multi-site and Multi-VISN Opioid / CN101 Rx Reviews
•National PBM identifies Large Quantity cases that are considered for Protected Peer Review
•Started June 2009
•National PBM identifies Large Quantity cases that are considered for Protected Peer Review
•Started June 2009
CN101 Large Quantity Rx Reviews
CN101 Large Quantity Rx Reviews
MethodsMethods
•Identify Top 10 Large Quantity patients in each VISN–10 or fewer cases per VISN per formulation
–Up to 30 cases possible per VISN
–Includes multi-VISN fills–Probably represents top 0.05% or less of all CN101 patients
•Identify Top 10 Large Quantity patients in each VISN–10 or fewer cases per VISN per formulation
–Up to 30 cases possible per VISN
–Includes multi-VISN fills–Probably represents top 0.05% or less of all CN101 patients
CutoffsCutoffs
•Intended to reduce size of database–Tab/cap: >= 1200 / 3 mo–Patches: >= 90 / 3 mo–Oral Liquid: >= 6000 / 3 mo
•Intended to reduce size of database–Tab/cap: >= 1200 / 3 mo–Patches: >= 90 / 3 mo–Oral Liquid: >= 6000 / 3 mo
Process for Large Quantity Cases
Process for Large Quantity Cases
10
PBM
CMOs COSs COPs
PPR Process:
2) PPR of selected
cases
VPEs
Re-evaluation of opioid care plan
Protected Peer Review Process:
1) Multidisciplinary Peer Cmte screen
AccountabilityAccountability
• PBM requires no follow-up; not involved in PPRs
• Multidisciplinary Peer Cmtes should ensure timely feedback to providers to ensure patient and public safety
• Quality Measure:
– CN101 utilization by Large Quantity patients (q6mo)
– National roll-up of PPRs
• Process Evaluation: Dec 2009
Reference Guide for PPRsReference Guide for PPRs
• Guides reviewers to potentially important aspects of care
• Available through VPEs and CMOs
• Guides reviewers to potentially important aspects of care
• Available through VPEs and CMOs
1 Choice of diagnostic tests and timely ordering of those diagnostic tests.
2 Performance of a procedure and / or treatment
3 Addressing abnormal results of diagnostic tests
4 Timeliness of diagnosis and appropriateness of diagnosis
5 Timing of treatment initiation and appropriateness of treatment
6 Adequacy of technique during procedures
7 Recognition and communication of critical clues to patient's condition during the period of clinical deterioration
8 Timely initiation of appropriate actions during periods of clinical deterioration
9 Medical record documentation 10 Supervision of health profession
trainees 11 Other relevant aspects of care
1 Choice of diagnostic tests and timely ordering of those diagnostic tests.
2 Performance of a procedure and / or treatment
3 Addressing abnormal results of diagnostic tests
4 Timeliness of diagnosis and appropriateness of diagnosis
5 Timing of treatment initiation and appropriateness of treatment
6 Adequacy of technique during procedures
7 Recognition and communication of critical clues to patient's condition during the period of clinical deterioration
8 Timely initiation of appropriate actions during periods of clinical deterioration
9 Medical record documentation 10 Supervision of health profession
trainees 11 Other relevant aspects of care
Questions?Questions?