Thursday, September 20, 2018
Gorman Medical, P.C., a pain management and primary care clinic, announced that it has partnered with Cordant Health Solutions™, a provider of innovative tools for monitoring and managing behavioral health and chronic pain patients through its unique pharmacy and drug testing program, to enhance care for Gorman's pain patients.
Finding a balance between treating those suffering from chronic pain and reducing the drug epidemic is creating tension for pain management providers, who are concerned that their patients' needs are overlooked and at times questioned. In addition, medications are often not available at every pharmacy, and patients are forced to travel to multiple pharmacies to get the medications they need.
"It's too simplistic to say that every patient who is prescribed opioids is going to abuse or misuse them. We should not forget that these medicines can be incredible tools in the right situations," said Fran Gorman, ANP-C, owner of Gorman Medical. "We are now running up against pharmacies who look at patients who are in debilitating pain and just see them as numbers, deciding if they should receive their medication or not with limited information."
Cordant is meeting the need for practical and data-driven solutions for physicians treating chronic pain patients by integrating drug testing and pharmacy reports. Synthesizing this information helps fill the gap between knowing what patients have been prescribed and whether they are taking their medication as directed or if other issues need to be addressed. Providing this data to prescribers allows them to make decisions based on a set of robust facts.
"By combining detailed pharmacy reports with drug testing results, we can identify patients who have a higher risk for misuse and therefore would benefit from greater intervention," said Gorman. "Most pharmacies work from protocols pushed down from a corporate office and decide based on that yes we will fill or no we won't. That attitude spills over to our patients, who are then treated poorly and judged as if they are doing something wrong by seeking appropriate medical care."
This kind of holistic patient care is also supported by Centers for Disease Control (CDC) in its guideline for prescribing opioids for chronic pain, published in March 2016, which states, "Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient's clinical situation, functioning, and life context. Clinicians should consider the circumstances and unique needs of each patient when providing care."
Said Gorman, "The CDC guideline was developed for primary care clinicians and is an important step in creating safe, more consistent prescriber practices around opioid medications in general. What's talked about less often is the difference between addiction and tolerance. Patients with debilitating chronic pain often have built up high tolerances for pain medications, which can seem excessive if you just look at the numbers. That's why the doctor-patient relationship is so significant. We can consider the circumstances and unique situation of each patient when making healthcare decisions, rather than relying on formulas."
Approximately 100 million people in the U.S. suffer from chronic pain. However, addiction and misuse of pain-controlling opioids have generated a national health crisis. Preliminary data from CDC estimates that 72,000 Americans died from drug overdoses in 2017, or 197 people a day, up from 174 a day in 2016.
In less than half a year, Gorman's partnership with Cordant is already producing results that indicate a decrease in patient risk, as estimated by looking at patient MME (or morphine milligram equivalent) levels. MME is an industry standard value based on morphine and its potency and is used to compare the potencies of different opioid medications. After only three months in Cordant's integrated drug testing and prescription monitoring program, 24 percent of Gorman's patients showed reduced MME levels, with an average decrease of 44 percent. In addition, 28 percent of pain patients who initially tested as being questionable with their treatment plan demonstrated improved compliance in their most recent test. Objective evidence of treatment compliance is a critical tool for providers to open dialogue with their patients and help them over any stumbling blocks that may interfere with patient understanding of how and when to take their medications.
Gorman clinicians and Cordant pharmacists have also consulted each other on 37 scripts (corresponding to more than 3,000 pills), ensuring high-quality patient treatment at every point of service.
"Our patients represent diverse populations and are prescribed controlled substances to help mitigate complex health issues," said Pete Zaharas, pharmacist-in-charge of Cordant's Denver pharmacy. "Some pharmacies turn away these patients because their needs and challenges are unfamiliar. It is important to remember that access to appropriate medications is vital to having quality of life. We work with our prescribers to ensure patients understand how to take their medications appropriately or alert the provider if a patient's well-being is in jeopardy. Every patient we serve is treated with dignity and respect, every time."