- Opioid use research has just taken a patient-centered turn at Cedars-Sinai. The Los Angeles hospital has recently received a $2 million grant from the Patient-Centered Outcomes Research Institute (PCORI) to investigate the most effective ways providers can discuss opioid use with patients, ultimately aiming to reduce opioid use while effectively managing chronic pain.
According to hospital officials, this research is unique because it is purely patient-centric, both in its approach to reducing opioid use and in assessing study results.
The research team, led by Brennen M. Spiegel, MD, will investigate two different patient-provider communication methods.
One cohort will receive patient education materials prior to each office visit informing them of the risks of opioid abuse and best practices for using painkillers. Clinicians treating the second patient cohort will receive electronic alerts prompting patient-provider discussions on opioid use prior to filling each prescription.
Study assessments will also be largely patient-centered, hospital officials say. One month following an initial hospital visit, researchers will survey patients about their quality of life, overall health, and how well they think physician communications worked for altering their opioid use.
The study will also leverage EHRs to collect opioid prescription data using pharmaceutical claims.
Additionally, the researchers will work with patients, patient advocates, addiction experts, and primary care providers to compare the effectiveness of the two communications strategies.
According to Itai Danovitch, MD, MBA, Director of Addiction Psychiatry at Cedars-Sinai, the patient-centeredness of this research is extremely valuable. While the researchers are looking to reduce the amount of opioid-related deaths and complications, they are also working to ensure their patients are comfortable and satisfied with their care.
"Incorporating patients' perspectives into the study design ensures that the findings will be relevant to real people in general medical practices, and not just some highly selected sample," said Danovitch, who is also the chair of Cedars-Sinai’s Department of Psychiatry.
"The focus on assessing 'quality of life' means that the study will extend beyond evaluating symptoms and will tell us whether the interventions impact health in a way that patients themselves find meaningful."
Opioid abuse is ravaging the country, with opioid overdoses killing nearly 33,000 individuals in 2015, per CDC figures. This is approximately quadruple the number of opioid-related deaths in 1999, hospital officials say.
"More people die of drug overdoses in the US than car accidents or guns. This sobering statistic reveals a massive, nationwide epidemic of opioid addiction that is costing lives and money," said Spiegel, who is also the director of Health Services Research at Cedars-Sinai.
"Our study will test whether we can use the electronic health record to disrupt how pain treatments are discussed and managed between patients and providers, with the goal of reducing inappropriate overuse of opioids."
Other healthcare stakeholders are working to fight the opioid crisis while still maintaining patient-centeredness and satisfaction. In July 2016, HHS proposed a revision to patient satisfaction measures that would reduce the emphasis on pain management, keeping providers from feeling pressured into overprescribing opioids.
“Many clinicians report feeling pressure to overprescribe opioids because scores on the HCAHPS survey pain management questions are tied to Medicare payments to hospitals,” the agency explained.
“In order to mitigate even the perception that there is financial pressure to overprescribe opioids, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation.”
As healthcare organizations and policymakers work to reduce opioid-related complications or deaths, they must consider a patient-centered approach. It will be important for healthcare professionals to find a balance between managing the opioid crisis will also ensuring compassionate and quality healthcare for patients.