{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T00:13:44Z","timestamp":1703722424761},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Concerns around opioid safety for patients living with chronic pain have led to a growing number of collaborative and multimodal pain care initiatives. A major challenge in these efforts has been identifying and engaging patients on high-risk opioid regimens in a timely manner.<\/jats:p><jats:p>\n          Objectives\u2003In this clinical informatics case report, we describe the development and implementation of a web-based tool to support providers as they implement an integrated pain support clinical initiative at primary care clinics across three health care systems.<\/jats:p><jats:p>\n          Methods\u2003The tool identifies patients on risky opioid medication regimens and generates autopopulated patient outreach letters. It contains three core functions that: (1) identify patients prescribed high-dose opioids or coprescribed opioids and benzodiazepines, (2) generate automated letters for patients with an upcoming primary care appointment, and (3) allow clinic staff to write back to a database to track outreach and referrals. Qualitative stakeholder feedback was gathered through interviews and user testing to assess perceived usefulness and ease of use of the tool.<\/jats:p><jats:p>\n          Results\u2003Over a 24-month period, the tool identified 1,125 patients prescribed risky medication regimens and generated 1,315 total letters as some patients became reeligible. Stakeholder feedback revealed that the tool was useful to quickly find patients on risky medication regimens and efficient in generating prepopulated letters that could be mailed in large batches. Additional feedback led to iterative refinements and improved system capabilities that varied across clinics.<\/jats:p><jats:p>\n          Conclusion\u2003Deploying clinical informatics tools that prioritize, engage, and track high-risk patient populations supports reduction of risky medication regimens. Such tools can reduce workload burden on busy primary care staff, particularly during implementation studies, and enhance patient-centered care through the use of direct-to-consumer outreach.<\/jats:p>","DOI":"10.1055\/s-0043-1777126","type":"journal-article","created":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T23:43:17Z","timestamp":1703720597000},"page":"1018-1026","source":"Crossref","is-referenced-by-count":0,"title":["A Tool to Identify and Engage Patients on Risky Opioid Regimens"],"prefix":"10.1055","volume":"14","author":[{"given":"Ashley C.","family":"Griffin","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States"},{"name":"Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taryn","family":"Perez","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tigran","family":"Avoundjian","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Becker","sequence":"additional","affiliation":[{"name":"Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States"},{"name":"Yale School of Medicine, New Haven, Connecticut, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda M.","family":"Midboe","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States"},{"name":"Division of Health Policy and Management, University of California Davis\u2014School of Medicine, Davis, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,12,27]]},"reference":[{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1002\/pds.4366","article-title":"Opioid analgesic dose and the risk of misuse, overdose, and death: a narrative review","volume":"27","author":"D T Coyle","year":"2018","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/MLR.0000000000000505","article-title":"A detailed exploration into the association of prescribed opioid dosage and overdose deaths among patients with chronic pain","volume":"54","author":"A S Bohnert","year":"2016","journal-title":"Med Care"},{"issue":"13","key":"ref5","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1056\/NEJMra1507771","article-title":"Opioid abuse in chronic pain\u2014misconceptions and mitigation strategies","volume":"374","author":"N D 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03","key":"ref9","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s11606-020-06253-8","article-title":"Benefits and harms of long-term opioid dose reduction or discontinuation in patients with chronic pain: a rapid review","volume":"35","author":"K Mackey","year":"2020","journal-title":"J Gen Intern Med"},{"issue":"11","key":"ref10","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1093\/pm\/pny231","article-title":"Does opioid tapering in chronic pain patients result in improved pain or same pain vs increased pain at taper completion? a structured evidence-based systematic review","volume":"20","author":"D A Fishbain","year":"2019","journal-title":"Pain Med"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1097\/j.pain.0000000000000907","article-title":"Sustained improvements in pain, mood, function and opioid use post interdisciplinary pain rehabilitation in patients weaned from high and low dose chronic opioid therapy","volume":"158","author":"K L Huffman","year":"2017","journal-title":"Pain"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1097\/j.pain.0000000000001763","article-title":"Reducing the use of opioids by patients with chronic pain: an effectiveness study with long-term follow-up","volume":"161","author":"M K Nicholas","year":"2020","journal-title":"Pain"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/AJP.0b013e3182579935","article-title":"Opioid cessation and multidimensional outcomes after interdisciplinary chronic pain treatment","volume":"29","author":"J L Murphy","year":"2013","journal-title":"Clin J Pain"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jpain.2016.11.003","article-title":"Prescription opioid taper support for outpatients with chronic pain: a randomized controlled trial","volume":"18","author":"M D 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suicide","volume":"14","author":"E M Oliva","year":"2017","journal-title":"Psychol Serv"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s11606-022-07617-y","article-title":"Effect of a predictive analytics-targeted program in patients on opioids: a stepped-wedge cluster randomized controlled trial","volume":"38","author":"K L Strombotne","year":"2023","journal-title":"J Gen Intern Med"},{"issue":"06","key":"ref22","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1001\/jamainternmed.2014.949","article-title":"Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial","volume":"174","author":"C Tannenbaum","year":"2014","journal-title":"JAMA Intern Med"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1136\/amiajnl-2010-000020","article-title":"Review of health information technology usability study 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