Background/Purpose: The use of opioids in treating chronic pain can be difficult and is a common problem across multiple specialties, including rheumatology. Opioid contracts have become more common place in various outpatient practices to help standardize the way in which physicians prescribe narcotic medications and sets expectations and goals for both the provider and patient¹. Currently, our office has no formal policy on prescribing controlled substances. This has led to lack of agreement between the expectations of health care providers and those of our patients resulting in frequent, unpredictable, and unsatisfactory number of phone calls and in-person interactions between patients and our staff related to narcotic prescriptions.

Methods: The objective of the study was to determine whether implementing a narcotic contract in the section of rheumatology will improve work flow by decreasing the number of narcotic-related EPIC phone messages. A rheumatology section meeting was held in July of 2015 regarding narcotic policy within TUH rheumatology practice and formal implementation of written narcotic contract was initiated in August 2015. Using questionnaires as a subjective measurement, we polled our staff of various positions (including physicians, nurses, medical assistant, and office personnel) on their perception of the number of narcotic prescription-related patient phone interactions both 6 months before and after initiation of the contract. Furthermore, using number of EPIC messages as our objective measurement of change, we compared the number of narcotic related phone encounters resulting in a narcotic prescription and the total number of narcotic prescriptions 6 months before and after the implementation of the contract. We also compared the total number of clinic encounters resulting in narcotic prescription 6 months before and after our intervention.

Results: Upon subjectively surveying our nurses and administrative assistants who handle the majority of incoming office phone calls, 2/4 perceived the number of narcotic-related phone calls as increasing and 2/4 thought the number of phone calls were unchanged over the one year study period. On provider surveys, 4/11 providers had patients formally sign the written contract and 6/7 providers who did not have patients formally sign the contract, verbally referred to the new policy during office visits. Seventy three percent of providers agreed that the contract had positive effect on office work flow. The total number of EPIC messages and total number of office visits resulting in narcotic prescription decreased by 20% and 16% respectively, after implementation of the contract.

Conclusion: Although, subjective perception regarding number of narcotic phone calls encountered by office personnel did not decrease based on survey responses, there was an overall objective decrease in number of phone calls after implementation of the narcotic contract.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/temple-university-hospital-rheumatology-narcotic-contract/