Does adding epidemiological information regarding back conditions to spine imaging reports result in reduced opioid prescribing? It's possible, and the approach could be a relatively easy way to tackle the problem of opioid overuse, according to a study published June 30 in the Journal of the American College of Radiology.
Since people presenting with lower back pain often undergo imaging, leveraging that moment in the healthcare continuum to influence the treatment decisions of healthcare providers makes sense, wrote a team led by Brian Bresnahan, PhD, of the University of Washington in Seattle.
"The process of implementing an intervention for lumbar spine imaging reports containing age- and modality-appropriate epidemiological benchmarks for common imaging findings ... seems to be a relatively low-cost, evidence-based, complementary tool that can be easily integrated into the reporting of spine imaging," the group wrote.
There's no doubt that the U.S. is in the midst of an opioid crisis, and many efforts are being made to address the problem. But these efforts continue to fall short.
"Non-guideline-based inappropriate use of opioids and potential adverse events, in general and with low back pain, continue to be concerning," the researchers wrote. "[Despite] published guidelines for low back pain, few effective strategies to encourage appropriate spine-related health care have been reported."
Bresnahan and colleagues investigated organizational resources needed and costs associated with establishing a decision-support intervention that consisted of adding age- and modality-matched prevalence information to lumbar spine imaging reports. They used data from the Lumbar Imaging with Reporting of Epidemiology (LIRE) trial, for which 238,886 patients underwent spine imaging between October 2013 and September 2016.
The team set a time frame of one month for personnel costs associated with the intervention and assessed these costs using ranges of per person efforts for different types of department staff. The basic framework for implementing the intervention consisted of the following:
- A medical doctor (radiologist, primary care provider, or other specialist) leads the intervention effort.
- This person guides radiology IT staff to put the decision-support language into spine imaging reports, directs a project manager, and communicates with ordering providers if needed.
- The project manager records and disseminates intervention results.
The team found that the expected average time to implement the intervention over the course of a month varied by type of provider, with IT programmers putting in the most time (six to 24 hours), and radiologists coming in second (three to 12 hours). Average base cost to put the intervention into place also varied by provider, but overall ranged between $2,651 to $12,020.
Although the study did not find that the intervention reduced spine-related relative value units (RVUs), it did reduce the number of opioid prescriptions written, measured by the percentage of patients receiving at least one opioid prescription within a year from a provider who used the LIRE intervention (from 37% to 36.2%, p = 0.04).
The intervention certainly shows promise, according to the study authors.
"Although we observed the reduction in opioid prescriptions during a period of intense pressure and several initiatives in the United States by health systems and health care organizations to reduce opioid prescribing, the LIRE intervention seems to provide a positive complement to other initiatives aimed at reducing opioid prescribing," they concluded. "Implementing LIRE may provide an additional tool for health systems looking to incorporate evidence-based information for providers."
