Opioid Therapy Practice and Policy Issues National Opioid Pain Care Agreement and Large Quantity Opi

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Opioid Therapy Practiceand Policy
IssuesNational Opioid Pain Care Agreementand
Large Quantity Opioid Prescription Review

• Francine Goodman, Pharm.D., BCPS
• Clinical Pharmacy Specialist, National PBM
  Services
• Project Leader, National Opioid Pain Care
  Agreement

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National Opioid Pain Care AgreementThree
Documents

• DIRECTIVE

• Supports
• a standard, national Opioid Pain Care Agreement
• a single location (Clinical Warnings / CWAD) in
  VHAs Computerized Patient Record System (CPRS)

• THE OPCA

• Available via iMedConsentTM program
• PATIENT INFORMATION
• Supplements the OPCA

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TO DO LIST

• Form work group
• Obtain field input
• Combine opioid agreements
• Distill core OPCA

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TO DO LIST

• Improve readability
• Pilot in patients
• Build consensus (ongoing)

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FINAL TO DOS

• (FY10)
• Submit to VACO for concurrence
• Post Model OPCA on VHA Pain Management Web
  sitehttp//www1.va.gov/pain_management/index.cfm
• Provider Education

STILL UNDER CONSTRUCTION
THANK YOU FOR YOUR PATIENCE
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Large Quantity Opioid Rx Reviews

• Goal
• To evaluate appropriateness (quality and safety)
  of aberrant large-quantity opioid prescriptions
• Extends Multi-site and Multi-VISN Opioid / CN101
  Rx Reviews

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CN101 Large Quantity Rx Reviews

• National PBM identifies Large Quantity cases that
  are considered for Protected Peer Review
• Started June 2009

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Methods

• Identify Top 10 Large Quantity patients in each
  VISN
• 10 or fewer cases per VISN per formulation
• Up to 30 cases possible per VISN
• Includes multi-VISN fills
• Probably represents top 0.05 or less of all
  CN101 patients

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Cutoffs

• Intended to reduce size of database
• Tab/cap gt 1200 / 3 mo
• Patches gt 90 / 3 mo
• Oral Liquid gt 6000 / 3 mo

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Process for Large Quantity Cases
PBM
Protected Peer Review Process 1)
Multidisciplinary Peer Cmte screen
CMOs COSs COPs
VPEs
Re-evaluation of opioid care plan
PPR Process 2) PPR of selected cases
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Accountability

• PBM requires no follow-up not involved in PPRs
• Multidisciplinary Peer Cmtes should ensure timely
  feedback to providers to ensure patient and
  public safety
• Quality Measure
• CN101 utilization by Large Quantity patients
  (q6mo)
• National roll-up of PPRs
• Process Evaluation Dec 2009

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Reference Guide for PPRs

• Guides reviewers to potentially important aspects
  of care
• Available through VPEs and CMOs

• 1 Choice of diagnostic tests and timely ordering
  of those diagnostic tests.
• 2 Performance of a procedure and / or treatment
• 3 Addressing abnormal results of diagnostic tests
  
• 4 Timeliness of diagnosis and appropriateness of
  diagnosis    
• 5 Timing of treatment initiation and
  appropriateness of treatment
• 6 Adequacy of technique during procedures
• 7 Recognition and communication of critical clues
  to patient's condition during the period of
  clinical deterioration
• 8 Timely initiation of appropriate actions during
  periods of clinical deterioration
• 9 Medical record documentation
• 10 Supervision of health profession trainees
• 11 Other relevant aspects of care

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Questions?