title: Evaluation of Health Plan Interventions to Influence Chronic Opioid Therapy Prescribing.
abstract: OBJECTIVE
  Evaluate health plan interventions targeting physician chronic opioid therapy (COT) prescribing.
  
  
  METHODS
  In 2006, Group Health's (GH) Integrated Group Practice (IGP) initiated diverse interventions targeting COT prescriber norms and practices. In 2010, the IGP implemented a COT guideline, including a mandated online course for physicians managing COT. These interventions were not implemented in GH's network practices. We compared trends in GH-IGP and network practices for 2006 to 2012 in the percent of patients receiving COT and their opioid dose. We compared physician beliefs before versus after the mandated course and precourse to postcourse changes in COT dosing for IGP physicians who took the course.
  
  
  RESULTS
  From 2006 to 2012, mean (SE) daily opioid dose among IGP COT patients (intervention setting) declined from 74.1 mg (1.9 mg) morphine equivalent dose (MED) to 48.3 mg (1.0 mg) MED. Dose changes among GH network COT patients (control setting) were modest-88.2 mg (5.0 mg) MED in 2006 to 75.7 mg (2.3 mg) MED in 2012. Among physicians taking the mandated course in 2011, we observed precourse to postcourse changes toward more conservative opioid prescribing beliefs. However, COT dosing trends did not change precourse to postcourse.
  
  
  CONCLUSIONS
  Following initiatives implemented to alter physician prescribing practices and norms, mean opioid dose prescribed to COT patients declined more in intervention than control practices. Physicians reported more conservative beliefs regarding opioid prescribing immediately after completing an online course in 2011, but the course was not associated with additional reductions in mean daily opioid dose prescribed by physicians completing the course.
authors.affiliation: Group Health Research Institute.
authors.forename: Kathleen W
authors.initials: KW
authors.lastname: Saunders
authors.affiliation: Group Health Research Institute.
authors.forename: Susan
authors.initials: S
authors.lastname: Shortreed
authors.affiliation: Departments of Psychiatry and Behavioral Sciences.|Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center.
authors.forename: Stephen
authors.initials: S
authors.lastname: Thielke
authors.affiliation: Departments of Psychiatry and Behavioral Sciences.|Rehabilitation Medicine.|Anesthesiology and Pain Medicine.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Turner
authors.affiliation: Oral Medicine, University of Washington.
authors.forename: Linda
authors.initials: L
authors.lastname: LeResche
authors.affiliation: Department of Physical Medicine and Rehabilitation, Group Health, Seattle, WA.
authors.forename: Randi
authors.initials: R
authors.lastname: Beck
authors.affiliation: Group Health Research Institute.
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff