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  • Measure Summary
  • NQMC:004208
  • Jul 2008

Substance use disorders: percentage of patients aged 18 years and older with a diagnosis of current opioid addiction who were counseled regarding psychosocial AND pharmacologic treatment options for opioid addiction within the 12 month reporting period.

American Psychiatric Association (APA), Physician Consortium for Performance Improvement® (PCPI), National Committee for Quality Assurance (NCQA). Substance use disorders physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Jul. 22 p. [11 references]

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in December 2015.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients aged 18 years and older with a diagnosis of current opioid addiction who were counseled regarding psychosocial and pharmacologic treatment options for opioid addiction within the 12 month reporting period.

Rationale

Methadone and buprenorphine, in combination with psychosocial treatment, are effective in reducing drug use and supporting treatment retention. Until recently, their use had been limited due to regulatory requirements with capacity at approved facilities only able to meet the treatment needs of 15% of opioid dependent individuals. While the increased access to opioid agonist treatments has resulted in an increase in their use, a large number of clinicians have yet to gain eligibility to prescribe the appropriate medications. Moreover, among physicians with waivers to prescribe buprenorphine, 33% were not actively prescribing. Pharmacotherapy and psychosocial treatment should be routinely considered for all patients with opioid addiction, and patients should be informed of this option.*

*The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

Empirically validated psychosocial treatment interventions should be initiated for all patients with substance use illnesses. (National Quality Forum [NQF])

Pharmacotherapy should be recommended and available to all adult patients diagnosed with opioid dependence and without medical contraindications. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment/support. (NQF)

Maintenance treatment with methadone or buprenorphine is appropriate for patients with a prolonged history (greater than 1 year) of opioid dependence. (American Psychiatric Association [APA])

Maintenance treatment with naltrexone is an alternative strategy, although the utility of this strategy is often limited by lack of patient adherence and low treatment retention. (APA)

Psychosocial treatments are effective components of a comprehensive treatment plan for patients with an opioid use disorder. Behavioral therapies (e.g., contingency management), cognitive behavioral therapies (CBTs), psychodynamic psychotherapy, and group and family therapies have been found to be effective for some patients with an opioid use disorder. (APA)

Note: Federal and state regulations govern the use of methadone, levo-alpha-acetylmethadol (LAAM), and buprenorphine, the three opioids approved by the FDA for the treatment of opioid dependence. (APA) [Note: since the publication of the APA practice guideline, LAAM is no longer available in the United States for agonist maintenance treatment.]

The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine issued a consensus statement to recognize and recommend definitions related to the use of opioids for the treatment of pain. They are as follows:

Addiction: Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Physical Dependence: Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

Tolerance: Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.

Addiction in the context of pain treatment with opioids is characterized by a persistent pattern of opioid misuse that may involve any or all of the following:

  • Use of prescription opioids in an unapproved or inappropriate manner (such as cutting time-release preparations, injecting oral formulations, and applying fentanyl topical patches to oral or rectal mucosa)
  • Obtaining opioids outside of medical settings
  • Concurrent abuse of alcohol or illicit drugs
  • Repeated requests for dose increases or early refills, despite the presence of adequate analgesia
  • Multiple episodes of prescription "loss"
  • Repeatedly seeking prescriptions from other clinicians or from emergency rooms without informing prescriber, or after warnings to desist
  • Evidence of deterioration in the ability to function at work, in the family, or socially, which appears to be related to drug use
  • Repeated resistance to changes in therapy despite clear evidence of adverse physical or psychological effects from the drug
  • Positive urine drug screen—other substance use (cocaine, opioids, amphetamines or alcohol)
  • Meets DSM IV criteria for dependence on opioids (VA/DoD)

Evidence for Rationale

American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine. Definitions related to the use of opioids for the treatment of pain. American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine; 2006.

American Psychiatric Association (APA), Physician Consortium for Performance Improvement® (PCPI), National Committee for Quality Assurance (NCQA). Substance use disorders physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Jul. 22 p. [11 references]

American Psychiatric Association (APA). Practice guideline for the treatment of patients with substance use disorders. 2nd ed. Washington (DC): American Psychiatric Association (APA); 2006 Aug. 275 p. [1789 references]

Merrill JO. Policy progress for physician treatment of opiate addiction. J Gen Intern Med. 2002 May;17(5):361-8. PubMed External Web Site Policy

National Quality Forum. National voluntary consensus standards for the treatment of substance use conditions: evidence-based treatment practices; a consensus report. Washington (DC): National Quality Forum; 2007.

Substance Abuse and Mental Health Services Administration. The determinations report: a report on the Physician Waiver Program established by the Drug Addiction Treatment Act of 2000 (DATA). Rockville (MD): Substance Abuse and Mental Health Services Administration; 2006 Mar 30. 8 p. [4 references]

U.S. Preventive Services Task Force. Screening for depression: recommendations and rationale. Rockville (MD): U.S. Preventive Services Task Force (USPSTF); 2002. 13 p. [13 references]

Veterans Health Administration, Department of Defense. VA/DoD clinical practice guideline for the management of opioid therapy for chronic pain. Washington (DC): Veterans Health Administration, Department of Defense; 2003 Mar.

Primary Health Components

Opioid addiction; counseling; psychosocial and pharmacologic treatment

Denominator Description

All patients aged 18 years and older with a diagnosis of current opioid addiction (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who were counseled regarding psychosocial AND pharmacologic treatment options for opioid addiction within the 12 month reporting period

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Professional certification

Measurement Setting

Ambulatory/Office-based Care

Behavioral Health Care

Rehabilitation Centers

Substance Use Treatment Programs/Centers

Professionals Involved in Delivery of Health Services

Physicians

Psychologists/Non-physician Behavioral Health Clinicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients aged 18 years and older with a diagnosis of current opioid addiction*

*The term "opioid addiction" in this context corresponds to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classification of opioid dependence that is characterized by a maladaptive pattern of substance use causing clinically significant impairment or distress, and manifesting by 3 (or more) of the 7 designated criteria. This classification is distinct from and not to be confused with physical dependence (i.e., tolerance and withdrawal) that is commonly experienced by patients with chronic pain who are treated with opioid analgesics.

Refer to the "Rationale" field for additional information regarding this distinction.

Exclusions
Patients may be excluded from the denominator for medical, patient or system reasons. Refer to the original measure documentation for details.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Patients who were counseled regarding psychosocial AND pharmacologic treatment options for opioid addiction within the 12 month reporting period

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Measure #2: counseling regarding psychosocial and pharmacologic treatment options for opioid addiction.

Measure Collection Name

Substance Use Disorders Physician Performance Measurement Set

Submitter

American Psychiatric Association - Medical Specialty Society

Developer

American Psychiatric Association - Medical Specialty Society

National Committee for Quality Assurance - Health Care Accreditation Organization

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Daniel Kivlahan, PhD (Co-Chair); Mark L. Willenbring, MD (Co-Chair); James G. Adams, MD; Joann Albright, PhD; Charles E. Argoff, MD; Ray M. Baker, MD; Richard L. Brown, MD, MPH; Audrey Burnam, PhD; Mirean Coleman, MSW, LICSW, CT; Edward C. Covington, MD; Thomas J. Craig, MD, MPH; Ann Doucette, PhD; Larry M. Gentilello, MD; Eric Goplerud, PhD, MA; Constance Horgan, ScD; Herbert D. Kleber, MD; Petros Levounis, MD; Bertha K. Madras, PhD; Frank McCorry, PhD; Ann H. Messer, MD; Michael M. Miller, MD, FASAM, FAPA; Doug Nemecek, MD, MBA; Harold Alan Pincus, MD; Rhonda Robinson-Beale, MD; Richard N. Rosenthal, MD; Darlene Warrick McLaughlin, MD; Scott C. Williams, PsyD

Beatrice Eld, American Psychiatric Association; Robert Plovnick, MD, MS, American Psychiatric Association

Joseph Gave, MPH, American Medical Association; Karen Kmetik, PhD, American Medical Association; Shannon Sims, MD, PhD, American Medical Association; Samantha Tierney, MPH, American Medical Association; Richard Yoast, PhD, American Medical Association

Lisa Nern, MSW, National Committe for Quality Assurance; Philip Renner, MBA, National Committe for Quality Assurance

Sylvia Publ, MBA, RHIA, Centers for Medicare & Medicaid Service

Rebecca Kresowik, PCPI Consultant; Timothy Kresowik, MD PCPI Consultant

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2008 Jul

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in December 2015.

Source(s)

American Psychiatric Association (APA), Physician Consortium for Performance Improvement® (PCPI), National Committee for Quality Assurance (NCQA). Substance use disorders physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Jul. 22 p. [11 references]

Measure Availability

Source not available electronically.

For more information, contact the American Psychiatric Association (APA) at 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209; Phone: 888-357-7924; E-mail: apa@psych.org; Web site: www.psychiatry.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on November 3, 2008. The information was verified by the measure developer on December 4, 2008.

This NQMC summary was retrofitted into the new template on June 13, 2011.

The information was reaffirmed by the measure developer on December 16, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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