A team-based approach to improving opioid management in primary care

The challenge

Most opioid prescriptions for chronic pain are provided in primary care — which means that primary care teams need an evidence-based quality improvement roadmap to help implement effective, guideline-driven care for patients with persistent pain. Although large health systems may be able implement initiatives to reduce opioid prescribing at scale, smaller primary care practices often lack the necessary resources and workforce.

The Six Building Blocks is an evidence-based program to help primary care clinics improve how they manage long-term opioid therapy for patients with persistent pain. The program was developed by the ACT Center in partnership with the University of Washington Department of Family Medicine and supported by funding from the Agency for Healthcare Research and Quality. It provides a quality improvement roadmap to help primary care teams implement effective, compassionate, patient-centered, and guideline-driven opioid therapy for patients with persistent pain.

The tools and resources we developed in the Six Building Blocks program include a model, an assessment, and a set of implementation guides. These tools are in the public domain, and you can find links to them in our resource library. Our longtime partners at Comagine Health are using and adapting these resources in their ongoing work to advance the Six Building Blocks model. Learn more on their website.

In a study of the effectiveness of the program we:

• Identified best practices from 20 exemplar primary care clinics across the United States that were selected for their use of team-based clinical innovations. These 6 best practice "building blocks" formed the basis of the program:
  • Provide supportive leadership and build consensus; 
  • Revise, align, and implement clinic policies, patient agreements, and workflows; 
  • Track and monitor patient care; 
  • Prepare for planned, patient-centered visits; 
  • Develop resources for “complex” patients with more needs; and 
  • Measure and celebrate success 
• Designed an implementation blueprint (the Six Building Blocks) to facilitate evidence-based quality improvement, including a program overview, self-assessment, and implementation guide. These resources describe team-based, systems-level clinical changes to help patients with persistent pain maximize their functional status and quality of life with a treatment plan that minimizes risk to patients and clinicians alike.
• Supported implementation of the Six Building Blocks in 6 rural-serving organizations, including 20 clinics, in eastern Washington and central Idaho. They are part of the UW’s Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region Practice and Research Network.
• Evaluated the effectiveness by comparing patient and clinic outcomes in participating sites to those of clinics in the same geographic areas that did not receive the program. Our evaluation found improvements in high-dose opioid prescribing as well as reduced work stress for clinicians and staff in clinics that implemented Six Building Blocks.

Impact

Six Building Blocks resources can be useful for anyone who is interested in improving the care of patients using long-term opioid therapy, such as practice facilitators, quality improvement advisors, clinicians and staff, and clinic administrators. 

The program has been adapted or recommended by a variety of organizations, including the Washington State Department of Health, Washington State's Bree Collaborative, the Oregon Health Authority, the Substance Abuse and Mental Health Administration (SAMHSA), and the Centers for Disease Control and Prevention (CDC). The ACT Center has also used the Six Building Blocks resources in designing the Integrated Pain Management Program at Kaiser Permanente Washington.