Joining <Your Organization’s Name> in Implementing the Six Building Blocks

1. Joining <Your Organization’s Name> in Implementing the Six Building Blocks A Team-Based Approach to Improving Opioid Management in Primary Care • The Six Building Blocks program has received funding from the Agency for Healthcare Research & Quality (R18HS023750), the Washington State Department of Health (Subcontract HED23124 of Cooperative U17CE002734, funded by the CDC), and the Washington State’s Olympic Communities of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC, NIH, the WA State Department of Health, or the Olympic Communities of Health. The Six Building Blocks Train-the-Trainer program is funded by National Institute on Drug Abuse (Award UG1DAO13714). This program has not been reviewed by NIDA and does not necessarily reflect the views of the Institute.

2. Agenda • Why <Your Organization’s Name> is participating in the Six Building Blocks program and why your clinic might want to join • What are the Six Building Blocks? • What do clinics need to be successful? • Are you ready to join? • Next steps

3. 130 Americans die every day from an opioid overdose that includes prescription opioids and heroin

6. In THE U.S., there WEre 59 opioid prescriptions written for every 100 people IN 2017.

7. In XXX COUNTY, there WEre XX opioid prescriptions written for every 100 people IN 2017.

8. Opioid Overdose Risk Dunn et al Ann Intern Med 2010

9. What do the guidelines say? • Use strategies to mitigate risk (e.g., naloxone) • Review PDMP data • Use urine drug testing • Avoid concurrent opioid & benzodiazepine prescribing • Offer treatment for Opioid Use Disorder • CDC Recommendations: • Opioids are not first-line therapy • Establish goals for pain and function • Discuss risks & benefits • Use immediate-release opioids when starting • Use the lowest effective dose • Prescribe short durations for acute pain • Evaluate benefits & harms frequently

10. What regulations do we need to know?

11. The Six Building Blocks: Supporting clinics in implementing best practices for opioid management

12. The Six Building Blocks derived from approaches taken among 20 primary care practices across the U.S. that were identified as having exemplar, team-based clinical innovations. Learning from Effective Ambulatory Practices (LEAP) study

13. Learnings from these practices were organized into the Six Building Blocks for Improved Opioid Management and published in the Journal of American Board of Family Medicine in February 2017 • http://www.jabfm.org/content/30/1/44.full#abstract-1

14. The Six Building Blocks

15. The Six Building Blocks

16. Studying the Six Building Blocks Program Developed a program to guide primary care organizations in implementing the Six Building Blocks Tested in 20 rural and rural-serving clinics in eastern WA and ID

17. Six Building Blocks Program • Development of an Opioid Improvement Team • Clinic-wide Kickoff • Ongoing guidance from a Practice Coach • Shared learning with others who are doing this project • Clinical education for providers and staff through UW TelePain • Action plan development to implement relevant Six Building Block elements, such as: • Revised policies, patient agreement, workflows • System for tracking and monitoring patients on long-term opioid therapy • Patient education materials and behavioral health resources • Resources for serving complex patients

18. Six Building Blocks Program Prescribing Outcomes The number of patients using long-term opioid therapy (LtOT) and the proportion on high dose opioids decreased

19. Six Building Blocks Clinician & Staff Experiences • Increased confidence and comfort in caring for patients with chronic pain • Increased collaboration and teamwork across the clinic • Decreased stress in providing care to patients using long-term opioid therapy • Improved relationships with patients using long-term opioid therapy • Seeing patients were receptive to change • Fewer negative interactions

20. Six Building Blocks Clinician & Staff Experiences "Having a defined care pathway for an emotionally charged and complex area of care - to walk in with a plan. It's like walking into the ER and someone having a cardiac arrest. Not the most stressful thing I do because we have a clear plan. Now I have the same kind of pathway for opioids. Having what we are going to do defined.” “Everybody that works in this clinic says to me, ‘Do you remember how much turmoil there was around it? Wow, we don’t have any of that anymore.’” “The thing that surprised me was the number of patients that once they started churning through the standard care pathway, that said, ‘Wow, I get it,’ and then a lot of them just ended up tapering themselves ahead of us. I just wasn't quite prepared to see the patients engage.”

21. Stages of Six Building Blocks Implementation

22. Factors that will help your clinic succeed in implementing the Six Building Blocks. • You have identified opioids as an area of concern and prioritized it as an area to work on. • Your clinic leadership is supportive of making system-based improvements to managing chronic pain and opioid prescribing • You have a staff member with quality improvement skills and experience who is interested in leading these improvements. • You have a clinician or champion who is passionate about improving the care of patients with chronic pain using long-term opioid therapy, and has some time to dedicate to the work.

23. Time Commitment by the Opioid Improvement Team Project manager: 2-8 hours per month Clinician Champion: 2-4 hours per month Tracking and Monitoring Lead: time spent depends on EHR system, measures chosen, etc. Other team members (e.g., Medical Assistant, Behavioral Health Provider, Pharmacist): 2 hours per month

24. How the program would work • A coach from <name of your organization> will work with the opioid improvement team at your clinic to: • conduct a baseline assessment • hold an in-person Kickoff Event with your clinic • provide ongoing guidance to develop and implement action plans to implement Six Building Blocks changes • provide access to Six Building Block resources, such as: • Model opioid management policy • Model patient agreement • Patient education materials • Strategies for tracking and monitoring • A guide for having difficult conversations with patients

25. Questions?

26. Explore this website to learn more www.improvingopioidcare.org

27. For more information, contact:<name of contact and how to contact>