July 1, 2016

Safe opioid prescribing guidelines

Safe Med LA County Coalition, which includes Kaiser Permanente, rolls out opioid abuse prevention guidelines to 80 urgent care clinics.

PASADENA, Calif. — Safe Med LA, a public/private prescription drug abuse coalition in Los Angeles County, today announced the launch of an initiative to implement safe prescribing guidelines at 80 urgent care clinics operated by 10 major physician groups and health systems throughout the county, including Kaiser Permanente and the Los Angeles County Department of Health Services.

“Opioid abuse is a public health epidemic,” said  Michael Kanter, MD, director of quality and clinical analysis for the  Southern California Permanente Medical Group. “It’s not just about cutting dosages of drugs. It’s about having a program that will benefit the patient and provide relief of pain without putting the patient at risk for complications of opioid abuse. It requires many professionals in different specialties providing input.”

Safe Med LA is taking a coordinated and multifaceted approach to address the opioid epidemic by focusing on a variety of factors, including safe prescribing, ensuring access to medication-assisted addiction treatment and overdose prevention medication, safe drug disposal, and community education. The first safe prescribing initiative, launched in March 2015, led to the adoption of the American Academy of Emergency Medicine guidelines in all 76 emergency departments throughout the county.

A shift in the medical community’s approach to pain management is starting to move patient care to more effective, safer pain management. The Safe Med LA guidelines and the Urgent Care patient information materials are part of the solution to combat opioid medication abuse.

“Kaiser Permanente Southern California started its work on safe opioid prescribing in 2010 and has achieved impressive results in reducing over-prescribing while effectively managing patients’ pain,” said Joel Hyatt, MD, emeritus assistant regional medical director, Community Health Improvement, Kaiser Permanente Southern California, and chair of the Safe Med LA Medical Practice Action Team.

Kaiser Permanente invested in provider re-education around the latest science of pain management and facilitated collaboration between primary care, pain management, addiction medicine, physical medicine, psychiatry and neurology.

“Our physicians and pharmacists welcomed guidance with prescribing and formulary policies, including restrictions and monitoring technology utilizing our electronic medical records system,” said Dr. Hyatt.

The program has demonstrated significant reduction in the prescribing of opioid medications that pose the highest risk for abuse and diversion into the community. Since January, 2010, Kaiser Permanente Southern California clinicians have reduced prescribing of the highest risk long-acting opioid medications (e.g., OxyContin, Opana) for non-cancer, non-hospice patients by over 72 percent; and reduced high-volume prescriptions of short-acting opioids (e.g., Vicodin, Norco, Percocet) by 98 percent, as documented by Kaiser Permanente's electronic medical records for members in Southern California.

“Our multifaceted approach ensures that tackling the issue of opioid abuse doesn’t get reduced to one variable, but is instead a comprehensive approach that emphasizes safe prescribing as well as prevention and patient education,” said Dr. Kanter.

On June 29, the California Health Care Foundation released Changing Course: The Role of Health Plans in Curbing the Opioid Epidemic. The CHCF-funded survey and accompanying white paper outline the efforts and results of 30 California health plans, including Medi-Cal, commercial and Medicare Advantage plans, to reduce opioid abuse.

The CHCF companion paper, Case Studies: Three California Health Plans Take Action Against Opioid Overuse , reports that “Kaiser Permanente Southern California’s framework for this change has now been spread across the national Kaiser Permanente enterprise, and the interventions it has adopted and found successful appear to be equally well suited to any sizable health plan.”

“The success we’ve had demonstrates that we can systematically reduce inappropriate overprescribing and reduce the risks of overdose, misuse, abuse and diversion, not only in our membership, but within the community, and we can do this while improving pain management,” notes Dr. Hyatt.

Safe Med LA has nine Action Teams focusing on different high-impact aspects of the opioid epidemic. The Medical Practice Action Team is leading the emergency department, urgent care and medical/dental practice initiatives.

The key members of the Medical Practice Action Team are: Los Angeles County Department of Public Health and the Los Angeles County Department of Health Services; Blue Shield; Kaiser Permanente and the Southern California Permanente Medical Group; Los Angeles County Medical Association; the Los Angeles Chapter of the American College of Physicians; the Los Angeles Chapter of the California Academy of Family Physicians; the Los Angeles Dental Society; the California American College of Emergency Physicians; University of California, Los Angeles; LA Care and others.

The 10 key participants (major provider groups and delivery systems) in the Urgent Care Initiative that operate the 80 urgent care clinics in Los Angeles County are: AltaMed, Care 1 st, Exer, Facey, Health Care Partners, Kaiser Permanente, the Los Angeles County Department of Health Services, Providence, UCLA and US Healthworks.

To learn more about Safe Med LA and the Urgent Care initiative, please visit the SafeMedLA website at http://www.safemedla.org/

For CHCF research and information on CHCF’s Opioid Safety Network Coalitions, go to: http://www.chcf.org/topics/opioid-safety

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 10.6 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.