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June's Quality Improvement Grantee Spotlight

Community Care of West VirginiaThis month, HRSA's Quality Improvement Program is highlighting the Primary Care Systems of West Virginia’s (PCSWV) quality improvement work and the success of their health center’s pain management program. PCSWV has instituted a strategic and effective approach for reducing prescription drug abuse among their patient population. This quality improvement initiative allowed PCSWV to create a safe and accountable environment for clinical staff to legitimately identify and treat patients with both acute and chronic pain.

Prescription Drug Abuse in the United States

West Virginia has one the highest rates of prescription drug abuse in the country, which makes PCSWV’s quality improvement work in prescription drugs particularly important. The Charleston Gazette reports, “In 1999, about 5 percent of West Virginians seeking treatment needed help for opiate addiction, according to federal figures. Last year, that proportion was more than 26 percent.”  West Virginia’s prescription drug problem is not an isolated incident and the problem of prescription drug abuse has spread across the country particularly in areas where safety net providers offer care. 

Nationwide, deaths from drug overdoses more than doubled between 1999 and 2007, according to the Centers for Disease Control and Prevention, with opiate painkillers fueling the increase. Recently, the Obama Administration voiced concerns in a recent report, entitled, "Responding To America's Prescription Drug Abuse Crisis",  over the increasing problem of prescriptions drug abuse and its effect on the nation’s communities.  

Primary Care Systems of West Virginia

Primary Care Systems of West Virginia (PCSWV) is a Federally Qualified Health Center (FQHC) serving the residents of Clay County, West Virginia and surrounding areas. PCSWV has two primary clinical locations in Clay and Big Otter within Clay County, and three school-based health centers. PCSWV serves approximately 7,200 patients with approximately 30,000 patient encounters annually. Of the patients served, over seventy percent are covered by Medicare or Medicaid or are uninsured. In addition, PCSW is a part of the Community Health Network of West Virginia exit disclaimer, a HRSA funded Health Center Controlled Network that uses the Resource and Patient Management System (RPMS) electronic health record (EHR) system.

Clay County Primary Health Care Clinic

PCSWV Using Quality Improvement to Address Pain Management Abuse

PCSWV Medical Director, Sarah Chouinard, M.D., believed  it was important for PCSWV and the community it serves to have an effective pain management program. According to Dr. Chouinard, "West Virginia is one of the worst places for prescription drug abuse, but it's also one of the places that I think has a high rate of legitimate chronic pain," Dr. Chouinard points out, “many of [her] patients work in labor-intensive jobs.…some work in the coal industry; Others trim trees, or do mechanical work on heavy machinery.”

In order to determine who legitimately needs pain medication, PCSWV developes a plan that each patient must adhere to. Failure to comply with the plan can result in the healthcenter refusing to continue prescribing the patient’s pain medication. The PCSWV pain management plan entails the following:

  • Patients sign an 18-point contract (PDF - 1 page) with the healthcenter.
  • Patients receive all medications at a single pharmacy.
  • Patients must keep their medicine in a secure place, like a locked cabinet or safe.
  • Patients cannot share or sell their pills.
  • Patients cannot use more medication than the doctor prescribes.

Furthermore, before the physician walks into the exam room, a PCSWV clinician is prepared with up-to-date information from the patient’s electronic medical record (EMR). This patient information includes the Board of Pharmacy reports showing which prescriptions patient has filled, as well as the results of a urine test and pill count. In addition, through the patient’s EMR, the clinician has information on the patient’s medical history, treatments, and PCSWV staff notes. This information helps the clinician determine if the patient is adhering to PCSWV’s pain management contract and how to further manage their care.

The Charleston Gazette reported, “This pain management plan has been so effective that in 2005, nearly 300 patients at the Clay site took narcotic pain medication. Today, it's fewer than 50.” In addition, PCSWV’s pain management plan supports physicians and other clinical staff wary of working in a health environment, such as a rural health center, where they might typically encounter high numbers of patients seeking prescription pain killers.

PCSWV has developed a system to ensure that patients adhere to the guidelines of their pain management program contract and appropriately use their pain medication. This prescription drug management program is a partnership with patients that provides oversight while preventing  abuse. In addition, PSCWV has created a safe environment for physicians skeptical about prescribing pain medication to treat their patients properly while maintaining accountability from both physicians and patients.

For more information, please email Sarah Chouinard, M.D., Medical Director.

Click here to view PCSWV’s Pain Management Contract (PDF - 1 page).

In addition, please visit the Substance Abuse and Mental Health Services Administration for addtional information on substance abuse prevention and information.