Factors that impact initiation of pain management agreements for patients on chronic opioid therapy.

Objective: This analysis seeks to understand variables within our institution that impact pain management agreement (PMA) utilization for chronic noncancer pain (CNCP).

Design: Retrospective chart review.

Setting: Public academic medical center.

Patients: Adults prescribed an opioid for CNCP between July 2020 and October 2020.

Main outcome measure: We assessed the association between patient demographics, prescription factors, and prescriber factors with the presence of a PMA. Unadjusted rates and chi-square tests were generated for each predictor. Additionally, we performed two multivariable logistic regressions: one including all variables and another utilizing a stepwise forward variable selection process to further understand the relationships between predictors and the presence of a PMA.

Results: 49.7 percent of patients who received an opioid for CNCP had a PMA on file. One significant predictor of the presence of PMA was prescriber specialty with anesthesia/pain medicine, demonstrating 88 percent compliance. Compared to anesthesia/pain medicine, patients receiving opioids from internal medicine had an odds ratio (OR) of 0.155 (95 percent confidence interval (CI), 0.109-0.220), while patients receiving opioids from family medicine had an OR of 0.122 (95 percent CI, 0.090-0.167). Additionally, patients who received schedule II opioids (as opposed to schedule III/IV opioids), patients with multiple opioid fills in 3 months, middle aged patients, and Black patients were more likely to have a PMA.

Conclusions: Compliance with PMA within our institution was only 49 percent despite an existing state law mandating use. Our analysis suggests quality improvement interventions should target patients on schedule III/IV opioids who receive their prescriptions from primary care providers.