Theme 7. Clinical innovations for specific populations
Each year more than 650,000 Ontario Drug Benefit (ODB) eligible Ontarians receive a prescription for opioids. This represents 20% of all ODB eligible residents. More than 34,000 are on long term opioid therapy. Today, prescription opioids are more likely to be found on the street than heroin and have become the drug of choice for teens. More than 3,000 opioid related emergency department visits and 640+ opioid related deaths occur each year. Primary care needs to focus on this issue! Through the use of innovative new EMR tools, we will demonstrate how primary care clinicians can optimize their approach to the safe prescribing of opioids and have a significant impact on the clinical outcomes of these patients.
Meeting the recommended prescribing requirements and having the time and expertise required to provide optimal, individualized opioid treatment for patients with chronic non-cancer pain is a real challenge for primary care physicians. In response to this, and built upon the updated 2017 Canadian Guidelines, through a collaborative effort supported by the Guelph FHT, the East Wellington FHT, the eHealth Centre of Excellence, and TELUS Health, a new set of EMR tools have been developed to enable clinicians to safely and effectively prescribe opioid medications to their patients with chronic non-cancer pain. These tools are presented in the form of a toolbar which appears in the patient’s chart within the EMR should they require opioid therapy. A highlight of the toolbar is that it displays the calculated morphine equivalents (MEQ’s) that the patient is on, and it turns color to attract attention when the levels are above certain ranges. The toolbar also includes a number of simple buttons which represent each of the guideline requirements (ex. pain condition diagnosis, risk screening, goal setting, informed consent, appropriateness of opioid(s) selected and dose, opioid effectiveness, and drug testing). The buttons also turn colour if any of the requirements are either missing or out of date, providing clinicians with an ‘at a glance’ view of the status of the patient’s opioid management. Clicking the buttons brings up standardized, evidence based tools used to manage their care. There are also buttons that provide links to other related tools, references, handouts and patient report cards. We look forward to sharing our experiences and results and to showing you how you can use these tools in your practices.
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