Origin and Process of Utah Guidelines

Anna Fondario, MPHUtah Department of Health

Violence and Injury Prevention Program

Fatalities linked to pain pills on the riseJanuary 21, 2005

Legal drugs: Deadly overdoses up dramatically among Utah residents; Drug deaths on the rise

across Utah“This was a horrendous problem…

a whole lot of people who died shouldn’t have died.”

--Dr. Todd Grey, Utah Chief Medical Examiner

The Bottom Line

• In 2006, six people were dying per week in Utah from legal prescriptions, mostly long-acting opioids.

• Two people died per week of an opioid prescribed legally within the preceding month.

• Prescription opioid deaths outnumbered motor vehicle crash deaths in 2007.

Prescription Pain Medication Management and Education Program

• Research– Causes, risk factors, solutions

• Prescribing Guidelines– “medical treatment and quality care

guidelines that are scientifically based; and peer reviewed”

• Educate– Health care providers, patients, insurers,

public

Collaboration

• Steering Committee– Meets monthly

• Advisory Committee– Open to all interested parties & stakeholders– Meets quarterly

• Work Groups– Patient and Community Education– Policy, Insurance, Incentives– Data, Research, Evaluation

Utah Clinical Guidelines on Prescribing Opioids

• Scope– For primary care and specialty physicians in

the state of Utah for guidance on prescribing opioids for both acute and chronic pain

• Target Audience– Clinicians who prescribe opioids in their

practice

Guidelines: Purpose

1. To provide recommendations that balance the benefits of use against the risks to the individual and society.

2. To provide useful tools to practitioners.

Steering Committee

• Developed – Key questions– Scope – Inclusion criteria used to guide the evidence

review process• Extensive review of existing guidelines

• Evaluation and inclusion criteria– Published after 1999– Disclosure of funding

• Scored on process– Evidence-based vs. consensus– 4 sets received scores <8– Reviewed by 3 public health professionals

Grading of Evidence and Recommendations

Expert Panels

• Guidelines Recommendation Panel– Formulated recommendations based on the

evidence-based guidelines• Implementation and Tool Panel

– Reviewed recommendations to ensure feasibility of implementation

– Determined tools for inclusion in guidelines

Guideline Recommendation Development Process

• First meeting– High-scoring guidelines distributed– Review for commonalities

• Second meeting– Additional guidelines– Wiki

Guideline Recommendation Development Process

• Third meeting– Straw poll

• Fourth meeting– Final discussions

• Tool workbook• Scoring• Elimination• Discussion

Tools Development Process

Open Comment Period

• 45 days• Resulted in > 80 comments

– Public Concerns• Introducing barriers• Impact of addiction

– Clinicians• Overall supportive

Dissemination

• Online / Print (mail / postcards)• Trainings / Conferences• Emails• Advertisement

– Utah Medical Association– Intermountain Health Care– Utah Hospital Association– Utah Medical Insurance Association– Utah Academy of Physician Assistants– Utah Pharmacy Association

HealthInsight

• Physician education– Small group trainings

• Up to 20 CME’s (follow up surveys)• 6 to 10 doctors• Required homework• Evaluation of behavior change

– Large group presentations• ~ 5 CME’s

– Mass mailings

Content Delivery Methods

• Education teams• Session content

– Data– Guidelines– Resource tool box– CSD tutorial– Referral options– Follow-up

Physician Education Objectives

• Increase safety of opioid prescribing via adoption of the guidelines

• After presentation, doctors will be able to...1. Implement “Six practices for safe opioid

prescribing”2. Identify tools to help physicians integrate

these practices into their work3. Assess improvement in prescribing patterns

in the first month and at six months

Evaluation

• System level changes such as inclusion of screening tools into electronic medical records will be needed to improve compliance with the Guidelines.

Evaluation

Questions