Abstract
OBJECTIVE: This study evaluated the efficacy of weekly shared medical appointments (SMAs) for opioid prescribing in addressing adherence, aberrance, and noncompliance in chronic pain patients receiving long-term opioid therapy (LTOT).
DESIGN: A retrospective observational study.
SETTING: This study was conducted as a structured intervention within a community pain specialty clinic that introduced a monitoring system over 12 months.
PARTICIPANTS: A total of 355 patients on LTOT were included, of whom 70 were identified as high-risk (Red status) due to noncompliance with opioid use policies.
INTERVENTIONS: Patients attended monthly telemedicine shared medical opioid education appointments delivered by pain specialists that aimed to increase adherence to practice standards. A stratified risk management approach was used, with patients categorized as Green, Yellow, or Red based on adherence behavior.
MAIN OUTCOME MEASURE(S): Primary outcome measures were changes in compliance status (Red to Yellow or Green), opioid prescription changes (morphine milligram equivalent, MME), and overall patient adherence improvement.
RESULTS: Of the 70 patients in Red status, 54 percent transitioned to Green status after weekly SMA participation. The median MME was reduced from 200 to 32. The most significant changes occurred among Red status patients, with 54 percent tapering off opioids completely. Compliance improved from 80 to 90 percent across all LTOT patients.
CONCLUSIONS: Weekly shared medical appointments significantly improved adherence and compliance among LTOT patients. The program highlights the utility of frequent touchpoints in managing high-risk patients and offers an adaptable model for other pain management clinics.