Planned, patient-centered visitsPrepare and plan for the clinic visits of all patients on long-term opioid therapy. Support patient-centered, empathic communication for care of patients on long-term opioid therapy.
Why is this important?
This is where the team can make a big impact! Care gaps can be identified by “scrubbing charts” the day before or during the morning huddle, resulting in delegation of tasks to different team members to close the gaps. For example, who is going to review the new patient agreement form with the patient and get their signature? Who is going to check the state prescription monitoring program database before the visit? Clinicians and staff can also briefly rehearse how to have difficult conversations with those few patients who have demonstrated aberrant behaviors, such as early prescription refill requests or an abnormal urine drug test.
- Use every visit to educate patients about chronic pain management and opioid risks
- Implement workflows to identify patients on long-term opioid therapy, monitor their charts, and prepare for visits
Prepare and plan for the clinic visits of all patients on long-term opioid therapy. Support patient-centered, empathic communication for care of patients on long-term opioid therapy.
|11. Planned opioid patient visits||123||456||789||101112|
|Before routine clinic visits, patients on long-term opioid therapy…||…are not identified. There is no preparation for patient visits for long-term opioid therapy.||…are sometimes identified, but there is no discussion or preparation for visits with patients prescribed long-term opioids therapy.||…are identified, and a discussion or chart review to prepare for the visit sometimes occurs.||…are consistently identified and discussed before the visit. The chart is reviewed and preparations made to address safe opioid use.|
|12. Empathic communication||123||456||789||101112|
|Training on patient-centered, empathic communication emphasizing patient safety, e.g., opioid risks, dose escalation, and to tapering…||…has not been offered to clinicians and staff.||…has been offered to clinicians and staff, but there was limited participation.||…has been offered and the majority of clinicians and staff participated.||…is consistently offered with widespread, regular participation.|
|13. Patient involvement||123||456||789||101112|
|Training on how to involve patients on chronic opioid therapy in decision-making, setting goals for improvement and providing support for self-management…||…has not been offered to clinicians and staff.||…has been offered to clinicians and staff, but there was limited participation.||…has been offered and the majority of clinicians and staff participated.||…is consistently offered with widespread, regular participation.|
|14. Care plans||123||456||789||101112|
|Chronic care plan* templates for chronic pain management…||…do not exist.||…exist, but do not align with current clinic policies and/or are not consistently used.||…exist, align with current clinic policies, but are not consistently used.||…exist, align with current policies, and are consistently used.|
|15. Patient education||123||456||789||101112|
|Patient education materials that include explanation of the risks, and limited benefits of long-term opioid use…||…do not exist.||…exist, but strategies to disseminate to patients do not exist.||…exist and dissemination strategies exist, but the strategies have not been fully implemented.||…exist, dissemination strategies exist, and the strategies have been fully implemented.|
*A chronic pain care plan is a tailored set of written steps and key information that a provider and patient agree will be used to manage the patient’s pain. It can include: goals (e.g., functional activities), current or planned treatments (e.g., physical activity prescription, medications), and a timeframe for reevaluation (e.g., follow-up in 3 months).
Planned, Patient-Centered Visits resources
Education resources for patients with chronic pain: A list of patient education materials relevant to patients with chronic pain, including resources about opioids, benzodiazepines, chronic pain, overdose, stigma, and pain self-management.
CDC patient education example: A handout for patients educating them on the risks of long-term use of opioids.
Patient letter: A letter introducing patients to the clinic’s new approach to caring for patients on long-term opioid therapy.
WA DOH chronic pain patient notification: A handout for patients educating them on the risks of long-term use of opioids, disposal, and safe storage.
WA DOH acute pain patient notification: A handout for patients educating them on the risks of acute use of opioids, disposal, and safe storage.
Chronic pain care plan example: A chronic pain care plan is a tailored set of written steps and key information that a provider and patient agree will be used to manage the patient’s pain.
BRAVO Protocol: The BRAVO protocol outlines a safe and compassionate strategy to approach opioid tapering, while also maintaining a therapeutic alliance.
VA Opioid Taper Decision Tool: The Opioid Taper Decision Tool is designed to assist Primary Care providers in determining if an opioid taper is necessary for a specific patient, in performing the taper, and in providing follow-up and support during the taper.
HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics: The Guide covers important issues to consider when changing a patient’s chronic pain therapy.
Provider guide to difficult conversations: Key principles and specific scripts to help providers navigate difficult conversations.
Staff guide to difficult conversations: Suggested conversation approaches and scripts for clinical and administrative staff who interact with patients on long-term opioid therapy.
Difficult Conversations video vignette: An example that illustrates using principles of how to have a difficult tapering conversation with a patient.
Empathic communication resources: A list of empathic communication and motivational interviewing resources.
Alternative treatments fact sheet: CDC recommended non-opioid treatments for chronic pain.
Evidence on complementary and alternative approaches to chronic pain: A summary of existing evidence for noninvasive non-pharmacological treatments and complementary health approaches for chronic pain conditions.
Chronic pain self-management resources: A list of suggested resources for providers, care coordinators, and patients to use for chronic pain self-management.
Health effects of cannabis and cannabinoids: Chapter highlights from the 2017 Report from The National Academies of Sciences, Engineering, and Medicine.
Planning for visits
Tips for managing patients on legacy prescriptions: Suggestions for how to approach patients you have inherited from another clinician.
Risk stratification and opioid prescribing: Suggestions for how to screen for and vary care according to risk level.
Turn the Tide pocket guide for clinicians: A quick reference for clinicians about opioid prescribing.
Pain Tracker: An example guide of assessments to use during visits about chronic pain.
Suggested opioid management schedule: A table outlining suggested tools and timelines for opioid management assessments.
Stigma and chronic pain: A resource describing the relationship between chronic pain and stigma. It includes approaches to address stigma in the primary care setting.
Social determinants of health and pain management: A document outlining the connection between social determinants of health and pain management, including resources to help plan patient visits.
For specific assessment tools, such as the Opioid Risk Tool, see Recommended Assessment table.
The CDC offers many helpful clinical tools on their website.