Creating and Implementing a Patient-Provider Agreement for Opioid Therapy

When prescribing opioid therapy, it is crucial to position it as one part of a comprehensive, multidisciplinary treatment plan. This approach should combine pharmacological treatments with non-pharmacological interventions to optimize pain management and improve overall well-being.

Key Components of a Comprehensive Treatment Plan:

  • Exercise and Physical Activity: Incorporating regular exercise to improve strength, flexibility, and pain tolerance.
  • Stress Management: Techniques like mindfulness and meditation to reduce emotional and psychological stress.
  • Physical Therapy: Engaging in targeted therapy to improve mobility, reduce pain, and prevent further injury.
  • Cognitive-Behavioral Therapy (CBT): Providing psychological support to address the emotional and cognitive aspects of chronic pain.

The treatment plan should also define mutual expectations between the patient and provider. This includes adherence to the treatment regimen and monitoring protocols to ensure safety and proper management of opioid use.

Essential Expectations and Agreements:

  • Regular Appointments: The patient should commit to attending scheduled visits consistently.
  • Pill Counts: Routine checks of the patient’s medication supply to ensure compliance.
  • Urine Drug Screens: Periodic testing to verify appropriate use of prescribed medications and screen for illicit substances.
  • Single Provider and Pharmacy: Medications should only be prescribed by one healthcare provider and dispensed through one pharmacy to minimize misuse.
  • Refill and Renewal Policies: Clearly outline the process and conditions under which medication refills or renewals are granted.

Key Questions for Patient Assessment

To gain a better understanding of the patient’s unique circumstances and ensure appropriate treatment, healthcare providers may ask the following questions across several domains:

Functional Status

  • Can you perform daily tasks such as cooking, cleaning, and shopping on your own?
  • Do you use any assistive devices for mobility?
  • Do you have help at home with daily activities?

Housing

  • Where are you currently living?
  • Are you stably housed or experiencing housing instability?
  • Does your living space have stairs that are difficult to navigate?
  • Do you feel safe in your current housing situation?

Childcare and Family Responsibilities

  • Are you responsible for the care of children?
  • Are there any additional family care responsibilities that may impact your treatment plan?

Relationships

  • Are you currently in a relationship?
  • Do you feel safe and supported within your relationship?

Support Network

  • Who are the individuals in your life that provide emotional or practical support?
  • Do you have a strong social or family support system?

Transportation

  • How do you typically get to medical appointments or other important destinations?

Employment

  • Are you currently employed?
  • Does your job or work environment affect your pain or ability to adhere to treatment?

Financial Situation

  • Does your income meet your basic needs, including housing, food, and transportation?

Mental Health History

  • Have you ever been hospitalized for psychiatric reasons?
  • Have you had a history of suicidal thoughts or attempts?
  • Are you currently receiving mental health treatment, or have you in the past?

Substance Use Abuse

  • Do you have a history of substance abuse (alcohol, street drugs, or prescription medications)?
  • Are you currently using any substances inappropriately?

Education and Literacy

  • What is the highest level of education you have completed?
  • Are you able to read and understand written information about your health?

Legal History

  • Have you ever been incarcerated or had legal issues?
  • Are there any current legal matters that could impact your treatment?

Spirituality and Community

  • Are you affiliated with any religious or spiritual organization that provides support or guidance in your life?

Sources:

  • Gourlay DL, Heit HA, Almahrezi A. Universal Precautions in Pain Medicine: A Rational Approach to the Treatment of Chronic Pain. Pain Med. 2005 Mar-Apr;6(2):107-112.
  • Nicolaidis C. Police Officer, Deal-Maker, or Health Care Provider? Moving to a Patient-Centered Framework for Chronic Opioid Management. Pain Med. 2011;12(6):890-897.
SideMenu
Scroll to Top