For patients with chronic pain — and the doctors who treat them — tapering off of prescription opioids has presented numerous challenges. Fear of the unknown and a lack of support for alternative pain management strategies have been common barriers for patients tapering off medication. From the providers’ perspective, there has been little guidance to help physicians understand clinical best practices and how to implement them. The dearth of resources has kept doctors from effectively tapering patients off of opioids.
Through extensive interviews with clinicians, patients, and other experts at Georgetown University and George Washington University, we identified the need for better tools to help people taper off their medications. It was also apparent that those tools needed to include Clinical Decision Support (CDS), infrastructure for better Patient-Reported Outcomes (PROs), and alternatives for chronic pain management. Vessel Partners teamed up with MedStar Health, a leading health system in the Washington D.C. area, in an AHRQ-funded project to give patients and providers new tools to address the opioid epidemic.
The result is TAPR-CPM — a pair of apps, integrated with multiple electronic medical record systems (EMRs) to support interoperability leveraging FHIR and SMART on FHIR.
We created web and mobile apps for patients that ask them to track their pain using PROMIS measures — which provide a clinically validated measure of their pain, allowing users and their doctors to compare their pain to a reference population over time. This assessment was implemented with Computer Adaptive Technology (CAT) to ask the fewest number of questions possible, lowering barriers to engagement and usability. In our interviews with chronic pain patients we uncovered several other features that can help provide better tools for managing chronic pain:
Additionally, the app provides patients with the information and support they need to understand the tapering process and reduce pain in new ways. Drawing on evidence-based, patient-friendly sources, MedStar and Vessel Partners put together a library of content suggestions that are delivered to the user at the right point in their journey for maximum impact. For instance, new users may be served an article about what to expect, while patients who are further along may get suggestions for mindfulness techniques or physical therapy that can help them cope with changing pain levels.
TAPR’s Clinical Decision Support Tool provides doctors and clinicians with the information they need to create evidence-based tapering plans that reduce withdrawal symptoms and failure rates.
Using patient information about specific medications and needs — such as the desired speed of the taper — the app provides recommendations for how to step down dosages over the right time period at the right rate based on a patient’s morphine milligram equivalent (MME). Tapering at the optimal pace is integral to success, so TAPR alerts clinicians if they attempt to go outside of evidence-based guidelines. Additionally, the app suggests alternative, non-opioid pain management therapies for doctors to prescribe, and ways to manage withdrawal symptoms.
Once the tapering process is underway, clinicians are able to monitor patient progress over time through the PROs collected in the patient app. The app provides clinicians with an easy to read timeline of the patient's taper including alerts if the patient's PRO scores have changed in a clinically significant way. At follow up visits, the doctor can then choose to slow down or otherwise alter the taper based on the patient generated data.
Ultimately, TAPR provides patients and clinicians with the right data and best evidence-based recommendations to guide each individual tapering experience toward a successful conclusion.
To learn more about TAPR-CPM, our other projects, and services, contact us.
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