Taking aim at opioid use

State-funded program targets back pain emergency room visitsAprilSCpic2


Back pain is a challenge to diagnose and treat and many people with back pain end up in hospital emergency departments seeking relief. Unfortunately, some pain medications can become addictive and must be prescribed with extra caution.

“For many clinicians, writing a prescription is the easiest way to handle these cases in what is often a hectic ED environment,” said Hallmark Health System Vice President of Medical Affairs and Chief Medical Officer Steven Sbardella, MD, who is also an emergency medicine physician. “But we want to ensure that when we prescribe a potentially addictive narcotic medication, we do so mindfully.”

Hallmark Health received a grant from the Massachusetts Health Policy Commission to develop a sustainable program that would reduce the rate of narcotic prescriptions for patients
with back pain in hospital EDs and urgent care clinics.

The program had three parts: analysis of practice variation, standardization of approach and documentation through development of a clinical practice guideline, and education focusing on pain management and alternative approaches.

The guideline requires prescribers to justify their decisions and document the name and dose of any medication, with a three-day maximum prescription. In addition, prescribers must check the patient’s medical record and the state’s prescription monitoring database. Finally, patients are referred back to their primary care physicians or to physical therapy for follow up and further treatment.

At the end of the six-month trial (January-June 2014) using the new guideline, the rate of narcotics prescribed for back pain in Hallmark Health EDs dropped substantially (see graph).

“This program more than accomplished its goal while also contributing to patient safety,”said Dr. Sbardella. “We are increasingly mindful of the risks and benefits of prescribing potentially addictive medications and we urge patients to cycle back with their physicians to discuss alternatives.”

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