Health Quality Ontario is collaborating with partner organizations across the health system on a coordinated program of supports to help clinicians manage their patients’ pain, including the appropriate use of opioids. The following provides a summary of what is or will soon be available through this program.
Helping patients manage pain is complex and extends beyond primary care.
We know there is a lot of attention on the use of opioids for pain management. We also know that our province has one of the highest rates of opioid use.
Amid the staggering numbers, enduring headlines drawing attention to crises, and the changing practice standards, we recognize the difficulty you face.
For this reason, we’d like to help support all family physicians by identifying some valuable resources to help you navigate this challenging landscape. Supports that extend beyond family physicians (other prescribers) are also in development.
Below, an example of a situation:
John is a solo FP in Woodstock. He’s recently reviewed the 2017 Canadian Guidelines for Opioids in Chronic Non Cancer pain. His patient with lower back pain has been to see him twice in the last month, asking for an increased dose. The patient is currently on 200 MEQ of oxycodone. Discussions about tapering his dose haven’t been well-received; John is feeling increasingly pressured by both his patient and by what he feels is a new standard of care that he must comply with.
John can turn to the following:
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A confidential report (My Practice: Primary Care) lets you see your own opioid prescribing patterns compared with the provincial average. Your personal data is available to you only – only you will be able to access it and view it. It cannot be accessed nor viewed by the Ministry of Health and Long-Term Care, or the College of Physicians and Surgeons of Ontario (available through Health Quality Ontario). To receive your first report, visit hqontario.ca/pcreport.
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Medical Mentoring for Addictions and Pain provides mentoring support that connects family physicians anywhere in Ontario with experts in chronic pain and addictions. Advice and mentorship from these experts is available at your convenience to help navigate the complexities in managing chronic pain, addictions and the current challenges around opioid prescribing (available through the Ontario College of Family Physicians)
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Digital tools like eConsult and EMR dashboard for optimizing the use of your EMR and the data in it to understand current patterns of care. Expert users of these tools are available to help you through the Peer Leader Program and the EMR Practice Enhancement Program. Interactive CME-accredited sessions near you as well as the accredited EMR Every Step Conferences are also available to educate practice staff on how your EMR can provide you with additional, immediate clinical value (all available through OntarioMD).
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Safer Opioid Prescribing webinars and workshops (available through the University of Toronto Faculty of Medicine, Continuing Professional Development)
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Quality Improvement Decision Support Specialists (QIDSS) and analytic support for Family Health Teams (available through the Association of Family Health Teams of Ontario)
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Weekly CME-accredited videoconferencing sessions with inter-professional pain specialist teams are available for primary care providers across Ontario. During these interactive sessions, participants learn about topics related to pain care and opioids and discuss complex chronic pain cases (available through Project ECHO).
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One-on-one educational outreach visits (also known as academic detailing) and access to clinical tools and supports focused on delivering providers with objective, balanced, evidence-informed information on best practices will be made available through the Centre for Effective Practice.
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Quality Standards outlining what quality care looks like for people with acute or chronic pain considering opioid therapy, and people with opioid use disorder (available through Health Quality Ontario; grounded in the 2017 Canadian Guideline for Opioids for Chronic Pain)
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Outreach to increase awareness of available supports and programs, and investments to increase access to addiction services (coordinated through the Local Health Integration Networks)
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A comprehensive continuing professional development program to provide coordinated education, training and support to health care providers on appropriate opioid and opioid replacement therapy prescribing (will be made available through Health Quality Ontario in partnership with other system partners)
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De-implementation of High-Risk Opioid Prescribing and Use Program (will be made available through Centre for Addiction and Mental Health and Association of Family Health Teams of Ontario)
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To assist with your pain medication review process, you may be able to access your patients’ clinically relevant drug and pharmacy service information via the Digital Health Drug Repository. To find out more about the Digital Health Drug Repository, contact Connecting.Ontario@ehealthontario.on.ca or click here.
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Reflect on your practice and see your own confidential opioid prescribing patterns
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Learn about other pain management options
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Learn how to run a query in the EMR for a more complete picture of your patient’s history
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Learn how to safely de-prescribe opioids, where appropriate
These supports are about knowing as much as possible about what’s available, what you can do, and who can help.
For more information about these partnered efforts, please contact: painQI@hqontario.ca