The 2017 Canadian Guidelines for Opioids for Chronic Non-Cancer Pain emphasized the importance of
safely minimizing the dose of opioids that patients are being prescribed. The
guidelines made it important for me as a primary care provider to reassess my
population of patients on opioids and ensure that I was doing my best to
implement the new recommendations accordingly. This presented a formidable
challenge and led to the realization that it would be very useful to have an
EMR tool to support this process.
In response, the East Wellington Family Health
Team (FHT), the Guelph FHT, the eHealth Centre of Excellence (eCE), and TELUS
Health partnered to create an
(Figure 1) using content informed by the Guidelines and work done
by the Centre for Effective Practice (CEP).
Figure 1. Opioid EMR Toolbar
The toolbar provided a practical and effective way to
implement the new guidelines into my practice through the following
The figure bellow illustrates the steps I took in
using the toolbar to implement the new guidelines.
Figure 2. Steps used to systematically manage my
population of patients on opioids.
During this process, I also found it very helpful to
provided by the CEP. These are one on one sessions in which an expert from the CEP met me
at my office and reviewed key topics including:
- Non-pharmacological and
non-opioid options for the management of patients living with chronic
- Managing opioid therapy for
patients living with chronic non-cancer pain
- Managing care for patients
living with opioid use disorder
The toolbar gave me the information that I needed,
when I needed it, provided individualized patient decision support, and saved
me a lot of time on documentation. I was able to spend more time with my
patients. They felt engaged and well informed.
Within nine months of the adoption of the toolbar I
was able to safely taper the dose of opioids for a significant number of my
patients and there was a statistically significant reduction in the overall MEQs
I prescribed over this time period (p<0.05).
I really hope that others will find
similar success in helping their patients manage their pain safely and
effectively. The Guidelines have paved the way for us, and the Opioid Toolbar
has proven to be an effective vehicle to help get us there.
Opioid Toolbar is now available
to all users of Telus
Practice Solutions EMR. The simplified
version of the toolbar used for this quality improvement initiative is
available through the
eHealthCentre of Excellence for PS EMR (Oscar under development). eHealth coaching
sessions are also available through the eCE (with Mainpro+ credits) for primary
care providers across the Waterloo-Wellington Local Health Integration Network.
Academic Detailing sessions
are free-of-charge and
free of commercial interest. Physicians
can earn Mainpro+ credits for each AD session. More information and the process
of signing up for a session is available on the
Centre of Effective Practice
Busse, J.W. (2017). The 2017 Canadian
guideline for opioids for chronic non-cancer pain. Hamilton, ON: McMaster
help supporting your patients in managing their pain?
Ontario Pain Management Resources for a coordinated program of tools from partner
organizations across the province.