title: Primary care monitoring of long-term opioid therapy among veterans with chronic pain.
abstract: OBJECTIVE
  To characterize long-term opioid prescribing and monitoring practices in primary care.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Primary care clinics associated with a large Veterans Affairs (VA) medical center.
  
  
  METHODS
  Adult patients who filled ≥6 prescriptions for opioid medications from the outpatient VA pharmacy between May 1, 2006 and April 30, 2007.
  
  
  METHODS
  Indicators of potential opioid misuse, documentation of guideline-recommended opioid-monitoring processes.
  
  
  RESULTS
  Ninety-six patients (57%) received a long-acting opioid, 122 (72%) received a short-acting opioid, and 50 (30%) received two different opioids. Indicators of some form of potential opioid misuse were present in the medical records of 55 (33%) patients. Of the seven guideline-recommended opioid-monitoring practices we examined, the mean number documented within 6 months was 1.7 (standard deviation [SD] 1.5). Pain reassessment was the most frequently documented process (N = 105, 52%), and use of an opioid treatment agreement was the least frequent (N = 19, 11%). Patients with indicators of potential opioid misuse had more documented opioid-monitoring processes than those without potential misuse indicators (2.4 vs 1.3, P < 0.001). After adjustment, potential opioid misuse was positively associated with the number of documented guideline-recommended processes (mean = 1.0 additional process, 95% confidence interval [CI] 0.4, 1.5).
  
  
  CONCLUSIONS
  Guideline-recommended opioid management practices were infrequently documented overall but were documented more often for higher risk patients who had indicators of potential opioid misuse. The relationship between guideline-concordant opioid management and high-quality care has not been established, so our findings should not be interpreted as evidence of poor quality opioid management. Research is needed to determine optimal methods of monitoring opioid therapy in primary care.
authors.affiliation: Center on Implementing Evidence Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA. krebse@iupui.edu
authors.forename: Erin E
authors.initials: EE
authors.lastname: Krebs
authors.forename: Darin C
authors.initials: DC
authors.lastname: Ramsey
authors.forename: James M
authors.initials: JM
authors.lastname: Miloshoff
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D016903:Drug Monitoring; D011307:Drug Prescriptions; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010146:Pain / Q000188:drug therapy*; D011320:Primary Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D000701:Analgesics, Opioid