An evaluation of the care provided to patients prescribed controlled substances for chronic nonmalignant pain at an academic family medicine center.
OBJECTIVE
Prescribing medications for chronic nonmalignant pain (CNMP) can be challenging for physicians for many reasons. In 1999, the state of Oregon implemented new guidelines governing the prescription of medications for CNMP. This study assessed the quality of care provided to CNMP patients, including the extent of compliance with the new state requirements 2 years after they were implemented.


METHODS
We used telephone records to identify patients who had called for prescription refills between mid 2001 and mid 2002. We then reviewed medical records of those patients to identify those who received refills for opioids or benzodiazepines for treatment of chronic pain. Medical records were evaluated to measure the percentage of records exhibiting documentation of compliance with state prescribing laws and other features indicative of a high standard of care.


RESULTS
Ninety seven percent of records included documentation of the diagnosis for which chronic therapy was indicated. Required Material Risk Notification Forms were absent from 100% of charts. Seventy-five percent of records document consultation with a pain specialist or other physician with specialty pertinent to the patient's source of pain. Medication contracts were only present in 39% of records, and documentation of a pain evaluation and functional evaluation was present in 67% and 54% of records, respectively.


CONCLUSIONS
Review of medical records in our clinic documented less-than-optimal compliance with state laws regulating prescribing for CNMP and the need for improvement in assessment and care of these patients.
Watkins
Angela
A
Department of Family Medicine, Oregon Health and Science University, Portland, 97201, USA.
Wasmann
Sam
S
Dodson
Lisa
L
Hayes
Meg
M
D000046:Academic Medical Centers; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D002908:Chronic Disease; D004282:Documentation / Q000592:standards; D004335:Drug and Narcotic Control; D006801:Humans; D007883:Legislation, Medical; D008499:Medical Records / Q000331:legislation & jurisprudence / Q000592:standards*; D009922:Oregon; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011398:Promethazine / Q000627:therapeutic use; D011787:Quality of Health Care; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D001569:Benzodiazepines; D011398:Promethazine