Planned, patient-centered visits

Prepare and plan for the clinic visits of all patients on chronic opioid therapy. Support patient-centered, empathic communication for care of patients on chronic opioid therapy.
Dr. Fern created an “Annual Pain Management” visit that allowed clinicians & patients to have dedicated time to discuss the patient’s pain, set goals, assess risks, and create a tapering plan for the upcoming year when appropriate.

Why is this important?

This is where the team can make a big impact! Care gaps can be identified by “scrubbing charts” the day before or during the morning huddle resulting in delegation of tasks to different team members to close the gaps. For example, who is going to review the new patient agreement form with the patient and get their signature? Who is going to check the state prescription monitoring program database before the visit? Clinicians and staff can also briefly rehearse how to have difficult conversations with those few patients who have demonstrated aberrant behaviors, such as early prescription refill requests or an abnormal urine drug test.

Katsura Medical Center has morning huddles to identify the chronic pain patients coming in that day, review what their needs are (e.g., urine drug test), and work to complete as much of that work as possible prior to the patient seeing the doctor.

Example activities

  • Use every visit to educate patients about chronic pain management and opioid risks
  • Implement workflows to identify patients on chronic opioid therapy, monitor their charts, and prepare for visits

Prepare and plan for the clinic visits of all patients on chronic opioid therapy. Support patient-centered, empathic communication for care of patients on chronic opioid therapy.

11. Planned opioid patient visits 123 456 789 101112
Before routine clinic visits, patients on chronic opioid therapy… …are not identified. There is no advance preparation for patient visits for chronic opioid therapy. …are sometimes identified, but there is no discussion or advance preparation for visits with patients prescribed chronic opioids. …are identified, and a discussion or chart review to prepare for the visit sometimes occurs. …are consistently identified and discussed before the visit. The chart is reviewed and preparations made to address safe opioid use.
12. Empathic communication 123 456 789 101112
Training on patient-centered, empathic communication emphasizing patient safety, e.g., opioid risks, dose escalation, and to tapering… …has not been offered to clinicians and staff. …has been offered to clinicians and staff, but there was limited participation. …has been offered and the majority of clinicians and staff participated. …is consistently offered with widespread, regular participation.
13. Patient involvement 123 456 789 101112
Training on how to involve patients on chronic opioid therapy in decision-making, setting goals for improvement and providing support for self-management… …has not been offered to clinicians and staff. …has been offered to clinicians and staff, but there was limited participation. …has been offered and the majority of clinicians and staff participated. …is consistently offered with widespread, regular participation.
14. Care plans 123 456 789 101112
Chronic care plan templates for chronic pain management… …do not exist. …exist, but do not align with current clinic policies and/or are not consistently used …exist, align with current clinic policies, but are not consistently used. …exist, align with current policies, and are consistently used.
15. Patient education 123 456 789 101112
Patient education materials that include explanation of the risks, and limited benefits of long-term opioid use… …do not exist. …exist, but strategies to disseminate to patients do not exist. …exist and dissemination strategies exist, but the strategies have not been fully implemented. …exist, dissemination strategies exist, and the strategies have been fully implemented.

*A chronic pain care plan is a tailored set of written steps and key information that a provider and patient agree will be used to manage the patient’s pain. It can include: goals (e.g., functional activities), current or planned treatments (e.g., physical activity prescription, medications), and a timeframe for reevaluation (e.g., follow-up in 3 months).

Planned, Patient-Centered Visits resources

CDC patient education example: A handout for patients educating them on the risks of chronic use of opioids.

Patient letter: A letter introducing patients to the clinic’s new approach to caring for patients on chronic opioid therapy.

Provider guide to difficult conversations: Key principles and specific scripts to help providers navigate difficult conversations.

Staff guide to difficult conversations: Suggested conversation approaches and scripts for clinical and administrative staff who interact with patients on chronic opioid therapy.

Difficult Conversations video vignette: An example that illustrates using principles of how to have a difficult tapering conversation with a patient.

Turn the Tide pocket guide for cliniciansA quick reference for clinicians about opioid prescribing.

Pain Tracker: An example guide of assessments to use during pain visits.

Alternative treatments fact sheet: CDC recommended non-opioid treatments for chronic pain.

Evidence on non-opioid approaches to chronic painA summary of existing evidence for noninvasive non-pharmacological treatments and complementary health approaches for chronic pain conditions.

Chronic pain self-management resources: A list of suggested resources for providers, care coordinators, and patients to use for chronic pain self-management.

For specific assessment tools, such as the Opioid Risk Tool, see Recommended Assessment table.

The CDC offers many helpful clinical tools on their website.