CCHE and ACT Center collaboration offers evidence for a patient-centered approach to improving opioid safety in primary care 

A new study published in BMC Primary Care provides evidence that interdisciplinary opioid safety committees (OSCs) can help primary care clinics reduce high-dose opioid prescribing while supporting a patient-centered approach to care for people experiencing persistent pain. Kaiser Permanente Washington Health Research Institute’s Center for Accelerating Care Transformation (ACT Center) supported primary care clinics in launching OSCs. CCHE led the qualitative evaluation, examining how the committees were implemented and what helped or hindered their success, and contributed to interpreting those findings alongside the quantitative results. 

A key component of the OSCs was their interdisciplinary nature; the OSCs brought together primary care providers, social workers, pharmacists, clinic operations leaders, and at least one additional care team member (e.g., nurse or medical assistant). Practice facilitators worked closely with the OSCs to select improvement priorities and to guide them through milestones such as assessing current practices for managing long-term pain, setting improvement priorities, and conducting chart reviews. Examples of improvement priorities included developing scripting for tapering conversations or optimizing naloxone distribution.  The OSCs also conducted peer review of complex cases, selecting patients based on opioid dose and opportunity for intervention within primary care.  The primary care provider whose patient was being reviewed was often in the room to provide additional context and to hear recommendations for their patients. The project relied on an advisory group composed of patients with lived experience of persistent pain who advised on key program elements and workflows (e.g., patient-centered provider scripting). A key contribution of this advisory group was a patient toolkit for managing persistent pain. 

The newly published evaluation examined opioid prescribing across 28 Kaiser Permanente Washington primary care clinics from 2019 through 2023, with additional analyses focused on the 9 clinics that implemented OSCs. As part of the mixed-methods evaluation, CCHE conducted interviews with 55 committee members to understand how the committees worked in practice, what supported implementation, and what challenges teams encountered. These qualitative findings helped provide context for interpreting changes seen in opioid prescribing.  

The findings showed that improvements in opioid safety took time to emerge. In clinics with OSCs, high-dose opioid prescribing of 90 or more morphine milligram equivalents declined by 19% after the committees had been in place for more than a year. Similar reductions were seen for prescribing at 50 or more morphine milligram equivalents and for concurrent prescribing of opioids and benzodiazepines. 

The evaluators also helped identify what made the approach work. Components that contributed to OSC success included having an interdisciplinary team, using a patient-centered approach, reviewing patient cases collaboratively with primary care providers, and leveraging practice facilitation expertise to support implementation. Key challenges included limited time for team members to engage in OSC activities, resistance to peer review from primary care providers, the complex nature of pain care, and the shortage of non-opioid treatment options. 

One of the clearest lessons from the study is the importance of sustained implementation. Significant reductions in high-dose prescribing were not seen until OSCs had been operating for more than 12 months. The findings suggest that health care organizations interested in improving opioid safety should consider not only what intervention to implement, but also the time, infrastructure, and ongoing support needed for it to take hold. 

CCHE team members Carly Levitz, Melissa Trapp-Petty, and Emily Bourcier are coauthors of the article, Reducing high-dose opioid prescribing in primary care: effectiveness of opioid safety committees, published August 10 in BMC Primary Care. 

Read the full article in BMC Primary Care.

For more information on the Opioid Safety Committee evaluation, contact:

• Claire Allen at Claire.L.Allen@kp.org with the ACT Center
• Carly Levitz at Carly.E.Levitz@kp.org with CCHE