Ann Arbor, MI — In a new initiative funded by the Agency for Health Research and Quality, Altarum and the University of Michigan are partnering to develop, implement, evaluate, and disseminate strategies to improve the management of opioid use, misuse, and opioid use disorder in older adults in primary care, including those in diverse populations.
While opioid use disorder afflicts a larger share of younger Americans, it is also a problem among people older than 65. Between 2002 and 2014, the rate of opioid misuse among older Americans nearly doubled. And while many initiatives have been developed to curb the opioid crisis, few have targeted the growing toll among older adults.
When prescribing opioids to older adults, it is important to balance pain relief and quality of life with the risk of opioid dependency, along with other factors including polypharmacy, cognitive and physical function, caregivers, social supportive services, and end-of-life preferences.
There also are areas for improvement when it comes to prescribing—according to AHRQ, it has not been uncommon in recent years for providers to prescribe more opioids to seniors than is recommended.
A key part of this project is integrating these practices so they are sustained over the long term, including assessing patient risk for opioid misuse, following-up with patients who have been prescribed opioids, using prescription drug monitoring databases to identify patients with multiple opioid prescriptions, and prescribing the recommended drugs and doses to manage pain in older adults effectively.
Altarum achieves sustained improvement in prescribing practices through a strategy that combines in-depth physician education with academic detailing and practice facilitators who provide direct technical assistance. We also extract and analyze data to provide feedback that further motivates physician behavior change. After delivering a similar program with the University of Michigan funded by the Health and Human Services Office of Minority Health, we saw substantial improvement in prescribing practices six months after the program concluded.
Daniel Berland, MD, of the University of Michigan, and Emily Ehrlich, MPH, director of Altarum’s Center for Behavioral Health, are co-principal investigators of the program. Dr. Berland is a clinical associate professor in the Departments of Medicine and Anesthesiology at the University of Michigan. He is also Board Certified in Internal Medicine and Addiction Medicine. Emily Ehrlich has led and participated in several nationally funded programs aimed at reducing opioid misuse. Altarum’s Joanne Lynne, MD, a former geriatrician and nationally recognized expert on issues related to palliative and end-of-life care, also will inform the program design.