Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

Laura-Mae Baldwin; Laura A Katers; Mark D Sullivan; Debra B Gordon; Adrienne James; David J Tauben; Saman Arbabi

doi:10.1136/tsaco-2022-001038

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

Trauma Surg Acute Care Open. 2023 Feb 20;8(1):e001038. doi: 10.1136/tsaco-2022-001038. eCollection 2023.

Authors

Laura-Mae Baldwin¹, Laura A Katers², Mark D Sullivan³, Debra B Gordon², Adrienne James², David J Tauben^{2

4}, Saman Arbabi⁵

Affiliations

¹ Department of Family Medicine and the Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA.
² Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA.
³ Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA.
⁴ Department of Medicine, University of Washington, Seattle, Washington, USA.
⁵ Department of Surgery, University of Washington, Seattle, Washington, USA.

Abstract

Background: Decreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients.

Methods: This longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP's identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support.

Results: The PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP's office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were.

Conclusions: This level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma.

Level of evidence: Level IV.

Keywords: Analgesics, Opioid; Delivery of Health Care; Health Care Quality, Access, And Evaluation; implementation.