1. Origin and Process of Utah Guidelines Anna Fondario, MPH Utah Department of Health Violence and Injury Prevention Program

3. Fatalities linked to pain pills on the rise January 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

4. 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.

6. 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

7. 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

8. 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

9. 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.

10. Steering Committee Developed –Key questions –Scope –Inclusion criteria used to guide the evidence review process Extensive review of existing guidelines

11. 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

12. 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

13. Guideline Recommendation Development Process First meeting –High-scoring guidelines distributed –Review for commonalities Second meeting –Additional guidelines –Wiki

14. Guideline Recommendation Development Process Third meeting –Straw poll Fourth meeting –Final discussions

16. Tool workbook Scoring Elimination Discussion Tools Development Process

17. Open Comment Period 45 days Resulted in > 80 comments –Public Concerns Introducing barriers Impact of addiction –Clinicians Overall supportive

18. 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

19. 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

20. Content Delivery Methods Education teams Session content –Data –Guidelines –Resource tool box –CSD tutorial –Referral options –Follow-up

21. 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 work 3.Assess improvement in prescribing patterns in the first month and at six months

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

23. Evaluation

26. Questions