Video: Adherence to opioid prescribing guidelines at an academic family medicine practice

Introduction: Opioid prescribing practices and guidelines are outlined by the United States Centers for Disease Control and Prevention (CDC), but limited data are currently available regarding their use in clinical practice. A primary care residency clinical site at an academic medical center attempted to improve compliance with the CDC best practices in 2022. As a quality improvement initiative, a policy was created, and education was provided to clinicians and patients. The clinical impact of these interventions was analyzed. Methods: A retrospective chart review was performed for patients on chronic opiates during 2023. Extracted electronic health record data were analyzed to collect information on the prescriber (resident/faculty/advanced practice provider), opioid type and duration, concurrent benzodiazepine use, and mental health diagnoses. The main outcomes were whether these patients had an opioid agreement and/or urine drug screen (UDS) in the past 12 months. Results: A total of 245 patients met the criteria, with 29 percent also being prescribed benzodiazepines, and 69 percent having at least one mental health diagnosis. Forty-one percent of the patients had a UDS in the electronic medical record in 2023, with the statistically significant predictors being nontramadol opioid use and a completed opioid agreement. Thirty-two percent had a completed opioid agreement, with the statistically significant predictors being a concomitant mental health diagnosis, provider type, and UDS obtained. Discussion/conclusion: Despite policy and education, compliance with our primary outcomes remained low. Residents were the most compliant. Tramadol was also uniquely identified as having lower compliance with having a UDS on file. Next steps include continued education efforts on the risk and best practices for reducing opioid-related harms and structured chart reviews.