title: Primary Care Clinic Re-Design for Prescription Opioid Management.
abstract: The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain.
  
  
  
  Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations. Site visits included interviews with leadership, clinic tours, observations of clinic processes and team meetings, and interviews with staff and clinicians. Data were reviewed to identify common attributes of clinic system changes around chronic opioid therapy (COT) management. These concepts were reviewed to develop narrative descriptions of key components of changes made to improve COT use.
  
  
  
  Twenty of the thirty sites had addressed improvements in COT prescribing. Across these sites a common set of 6 Building Blocks were identified: 1) providing leadership support; 2) revising and aligning clinic policies, patient agreements (contracts) and workflows; 3) implementing a registry tracking system; 4) conducting planned, patient-centered visits; 5) identifying resources for complex patients; and 6) measuring progress toward achieving clinic objectives. Common components of clinic policies, patient agreements and data tracked in registries to assess progress are described.
  
  
  
  In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing COT patients in primary care settings.
authors.affiliation: From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS). parchman.m@ghc.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
authors.affiliation: From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS).
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.affiliation: From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS).
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.affiliation: From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS).
authors.forename: Mark
authors.initials: M
authors.lastname: Stephens
authors.affiliation: From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS).
authors.forename: Brooke
authors.initials: B
authors.lastname: Ike
authors.affiliation: From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS).
authors.forename: DeAnn
authors.initials: D
authors.lastname: Cromp
authors.affiliation: From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS).
authors.forename: Clarissa
authors.initials: C
authors.lastname: Hsu
authors.affiliation: From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS).
authors.forename: Ed H
authors.initials: EH
authors.lastname: Wagner
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D059350:Chronic Pain / Q000188:drug therapy*; D006801:Humans; D007857:Leadership; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D010355:Patient Identification Systems; D017410:Practice Guidelines as Topic; D000067490:Prescription Drug Overuse / Q000517:prevention & control*; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement; D014481:United States
chemical_list: D000701:Analgesics, Opioid
keywords: Ambulatory Care Facilities; Analgesics; Chronic Pain; Drug Overdose; Leadership; Opioid; Opioid-Related Disorders; Prescriptions; Primary Health Care; Registries; Research Personnel; Workflow