Opioid Therapy Practiceand Policy Issues

National Opioid Pain Care Agreementand Large Quantity Opioid Prescription

ReviewFrancine Goodman, Pharm.D., BCPS

Clinical Pharmacy Specialist, National PBM ServicesProject Leader, National Opioid Pain Care Agreement

National Opioid Pain Care Agreement

Three DocumentsDIRECTIVESupports • a standard, national

Opioid Pain Care Agreement

• a single location (Clinical Warnings / CWAD) in VHA’s Computerized Patient Record System (CPRS)

THE OPCA

Available via iMedConsentTM program

PATIENT INFORMATIONSupplements the OPCA

TO DO LIST

Form work groupObtain field inputCombine opioid

agreementsDistill core OPCA

TO DO LIST

Improve readability

Pilot in patientsBuild consensus

(ongoing)

FINAL TO DO’S(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

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

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

•Started June 2009

CN101 Large Quantity Rx Reviews

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

Cutoffs•Intended to reduce size of

database–Tab/cap: >= 1200 / 3 mo–Patches: >= 90 / 3 mo–Oral Liquid: >= 6000 / 3 mo

Process for Large Quantity Cases

10

PBM

CMOs COSs COPs

PPR Process:2) PPR of selected

cases

VPEs

Re-evaluation of opioid care plan

Protected Peer Review Process:

1) Multidisciplinary Peer Cmte screen

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

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

Questions?