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Dr. David Kaplan

MyPractice: My Primary Care

According to a recent report from Health Quality Ontario, 9 Million Prescriptions, one in seven Ontarians fills a prescription for opioids every year. More than 9 million prescriptions for opioids were filled in the province in 2015/16. Canada remains the second-largest consumer of prescription opioids in the world, after the US.

Unfortunately, many patients are receiving these highly addictive drugs, from both legitimate and illicit sources, with only questionable benefit. This is a complex problem involving many health care providers and many interwoven factors compounding the situation.

While physicians are faced with the challenges of treating patients with often complex disorders and few resources, more appropriate prescribing by all physicians is part of the solution.

Health Quality Ontario and its partners will be helping family doctors more appropriately prescribe opioids by giving them access to a confidential report, called MyPractice, which details their opioid prescribing patterns in comparison to others in the province. This is part of a coordinated strategy by a number of primary care organizations in the province working together on key supports for clinicians to help navigate the complexities of helping their patients manage pain.

These supports include mentoring to help primary care providers manage patients with substance use disorders, webinars and workshops on safe opioid prescribing, access to decision support specialists and analytic support for family health teams, and access to the National Narcotics Monitoring Network to identify when patients are receiving drugs from multiple sources.

All physicians aspire to provide quality care, but this desire is often hampered by the difficulty in accessing useful and timely information for and about their patient populations.

Helping provide access to data, tools and supports is one of the key objectives of the MyPractice reports. In our roadmap for quality health care, Quality Matters: Realizing Excellent Care for All, we have committed to “redoubling efforts to get local performance data into the hands of clinicians looking to improve their practice.”

Writing in the Huffington Post earlier this year, Health Quality Ontario’s Dr. Joshua Tepper stated one action that could help deal with the opioid crisis would be to: “introduce better systems to monitor opioid prescribing.” He added: “As Tara Gomes, a Principal Investigator of the Ontario Drug Policy Research Network, said recently, ‘if prescribers knew the history when they saw a patient, it would avoid those prescriptions being written in the first place.’

MyPractice reports are confidential documents prepared by Health Quality Ontario that give family and long-term care physicians an informative perspective of their individual practice. Identifiable physician-level data is only released to the participating physician and will not be shared with other parties without additional written consent of the participating physician.

New enhancements to these reports now also give family physicians the ability to view their individual opioid prescribing patterns in comparison to others, with links to practical change ideas and key supports provided by a number of partner organizations. For those using electronic medical records, we will also be distributing tools to use the data available in their systems to target specific individuals in need of attention.

In addition, MyPractice reports provide practice ideas specific to improvement topics -- that means less effort and time finding solutions that may already exist.

When I examined a preview of my own MyPractice report, I uncovered a shocking fact. Of the patients on my roster who have been prescribed an opioid in the last six months, over 70% of them received the drug from another prescriber — not me. This has prompted me to include a question about prescription opioid use in my periodic heath review EMR template. Hopefully, this screening question will help me identify and manage these patients better.

I hope that having access to this kind of information and tools will similarly help provide my fellow family doctors with the tailored information needed to help them follow the new Canadian guidelines on use of opioids to manage chronic non-cancer pain.

MyPractice reports with the opioid prescribing data were developed jointly by Health Quality Ontario and the Institute for Clinical Evaluative Sciences, in partnership with the Association of Family Health Teams of Ontario, the Ontario College of Family Physicians, and the Centre for Effective Practice.

My Practice reports are just one way in which family doctors in the province are receiving direct assistance when it comes to opioid prescribing, with more supports to come.

Dr. David Kaplan is a family physician and Provincial Clinical Lead, Primary Care at Health Quality Ontario.


1 comments on article "MyPractice: My Primary Care"

Scott Farraway

A very interesting article outlining the supports to physicians to assist in monitoring patient opioid use and abuse. I am a provider of health care services in the community sector and have worked in the ABI field for 30 years. I am also the spouse of a patient with chronic pain for the past 20 years. We have run the gamete of chronic pain treatment options, been seen by multiple specialists over the years. Opioids, although not perfect, have provided necessary relief for my wife and a degree of life quality that nothing else has done. In the past 6 months her access has been reduced significantly, primarily as a result of physicians being intimidated by the new opioid standards and the way in which the ministry and college are policing physicians treatment of patients with chronic pain. We recognise the crisis that has developed around the use of opioids illegally or outside of the prescribed dosages. People seeking out multiple sources of opioids suggests that they are drug seeking due to an addiction problem. Another equally plausible reason for seeking multiple prescribers is that the treatment being offered is inadequate and ineffective in managing pain. It would be interesting to see what would happen if people with chronic pain had advocates who worked with the prescribing physicians to monitor, support, collect functional objective pain related data and report that information back to the physician to assist in medication titration and other possible treatment alternatives. To assume that a physician has the time to use the tools outlined in this article may be ambitious. Why not provide a community outreach team for patients who help to manage the chronic pain caseload and assist physicians in analysing data to ensure effective and safe treatment?

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