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Origin and Process of Utah Guidelines

Origin and Process of Utah Guidelines. Anna Fondario , MPH Utah Department of Health Violence and Injury Prevention Program. Fatalities linked to pain pills on the rise January 21, 2005.

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Origin and Process of Utah Guidelines

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  1. Origin and Processof Utah Guidelines Anna Fondario, MPH Utah Department of Health Violence and InjuryPreventionProgram

  2. 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

  3. 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.

  4. 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

  5. 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

  6. 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

  7. Guidelines: Purpose • To provide recommendations that balance the benefits of use against the risks to the individual and society. • To provide useful tools to practitioners.

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

  9. Grading of Evidence and Recommendations • 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

  10. 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

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

  12. Guideline Recommendation Development Process • Third meeting • Straw poll • Fourth meeting • Final discussions

  13. Tools Development Process • Tool workbook • Scoring • Elimination • Discussion

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

  15. 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

  16. 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

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

  18. Physician Education Objectives • Increase safety of opioid prescribing via adoption of the guidelines • After presentation, doctors will be able to... • Implement “Six practices for safe opioid prescribing” • Identify tools to help physicians integrate these practices into their work • Assess improvement in prescribing patterns in the first month and at six months

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

  20. Evaluation

  21. Questions

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