{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:11:10Z","timestamp":1777932670045,"version":"3.51.4"},"reference-count":28,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Population Health Management"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>\n                    In response to the opioid epidemic, the Centers for Disease Control and Prevention released best practice recommendations for prescribing, yet adoption of these guidelines has been fragmented and frequently met with uncertainty by both patients and providers. This study aims to describe the development and implementation of a comprehensive approach to improving opioid stewardship in a large network of primary care providers. The authors developed a 3-tier approach to opioid management: (1) establishment and implementation of best practices for prescribing opioids, (2) development of a weaning process to decrease opioid doses when the risk outweighs benefits, and (3) support for patients when opioid use disorders were identified. Across 44 primary care practices caring for &gt;223,000 patients, the total number of patients prescribed a chronic opioid decreased from 4848 patients in 2018 to 3106 patients in 2021, a decrease of 36% (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u20090.001). The percent of patients with a controlled substance agreement increased from 13% to 83% (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u20090.001) and the percent of patients completing an annual urine drug screen increased from 17% to 53% (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u20090.001). The number of patients coprescribed benzodiazepines decreased from 1261 patients at baseline to 834 at completion. A total of 6.5% of patients were referred for additional support from a certified alcohol and substance abuse counselor embedded within the program. Overall, the comprehensive opioid management program provided the necessary structure to support opioid prescribing and resulted in improved adherence to best practices, facilitated weaning of opioids when medically appropriate, and enhanced support for patients with opioid use disorders.\n                  <\/jats:p>","DOI":"10.1089\/pop.2023.0234","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T16:06:45Z","timestamp":1705594005000},"page":"1-7","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comprehensive Approach to Opioid Management in a Primary Care Network"],"prefix":"10.1177","volume":"27","author":[{"given":"Robert J.","family":"Fortuna","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Rochester, Rochester, New York, USA."},{"name":"Primary Care Network, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jineane","family":"Venci","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wallace","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Rochester, Rochester, New York, USA."},{"name":"Primary Care Network, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S.","family":"Clark","sequence":"additional","affiliation":[{"name":"Primary Care Network, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shalom","family":"Schlagman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Vandermark","sequence":"additional","affiliation":[{"name":"Primary Care Network, University of Rochester, Rochester, New York, USA."},{"name":"Department of Psychiatry, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alisa","family":"Stetzer","sequence":"additional","affiliation":[{"name":"Primary Care Network, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George S.","family":"Nasra","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheniece (Griffin)","family":"Martin-Stancil-El","sequence":"additional","affiliation":[{"name":"Primary Care Network, University of Rochester, Rochester, New York, USA."},{"name":"School of Nursing, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Judge","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Rochester, Rochester, New York, USA."},{"name":"Primary Care Network, University of Rochester, Rochester, New York, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,2,6]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6736a2"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.j.pain.0000460357.01998.f1"},{"issue":"42","key":"e_1_3_5_4_2","first-page":"1171","volume":"58","author":"Overdose deaths involving prescription opioids among Medicaid enrollees\u2014Washington","year":"2009","unstructured":"Overdose deaths involving prescription opioids among Medicaid enrollees\u2014Washington, 2004\u20132007. MMWR Morb Mortal Wkly Rep, 2009; 58(42):1171\u20131175.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"14","key":"e_1_3_5_5_2","first-page":"377","article-title":"Poisoning deaths involving opioid analgesics\u2014New York State, 2003\u20132012","volume":"64","author":"Sharp MJ","year":"2015","unstructured":"Sharp MJ, , Melnik TA. Poisoning deaths involving opioid analgesics\u2014New York State, 2003\u20132012. MMWR Morb Mortal Wkly Rep, 2015; 64(14):377\u2013380.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6610a1"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1464"},{"key":"e_1_3_5_8_2","unstructured":"Centers for Disease Control and Prevention. Guideline for Prescribing Opioids for Chronic PainPromoting Patient Care and Safety. https:\/\/www.cdc.gov\/drugoverdose\/pdf\/Guidelines_At-A-Glance-508.pdf Accessed 12\/2023."},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnab208"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/add.15359"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2018.09.022"},{"key":"e_1_3_5_12_2","unstructured":"Prescribing Policies: States Confront Opioid Overdose Epidemic. Washington DC: National Conference of State Legislatures; 2017."},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000004760"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1904190"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2017.s92"},{"key":"e_1_3_5_16_2","unstructured":"Centers for Disease Control and Prevention. Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain. Atlanta GA: Division of Unintentinal Injury Prevention National Center for Injury Prevention and Control; 2018."},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7103a1"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-009-0981-1"},{"key":"e_1_3_5_19_2","unstructured":"Hargan ED . Determination that a Public Health Emergency Exists . Office of the Secretary Department of Health and Human Services; . https:\/\/www.phe.gov\/emergency\/news\/healthactions\/phe\/Pages\/opioids.aspx Accessed December7 2023."},{"key":"e_1_3_5_20_2","unstructured":"Health and Human Services. Pain Management Best Practices Inter-Agency Task Force. 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