In my experience of reviewing thousands of patient histories for chronic pain management in greater than 15 states, including extensive physician chart notes, the overwhelming majority of prescribers of opioids in chronic pain management [excluding cancer related pain, palliative care and sickle cell anemia (because there exists bonafide clinical evidence in the safety and effectiveness in these conditions)], the results are this: The vast majority of prescribers are NOT following evidence based medicine as a general guideline, not even close. This includes pain management specialists. But don’t worry, the PBM’s have their market shares/rebates to protect for their bottom line, so chances are, the prior auths will get a approved. And if not, they’re making plenty of money on their market shares/rebates of buprenorphine products. Win-Win for them.
Opioids Don’t Treat Chronic Pain Any Better Than Ibuprofen: Study
The above comment was made by someone who identified themselves as a PharmD. It was one of several comments on a post that referenced the above Newsweek article. From what this PharmD stated at the end of the comment he/she does reviewing of pt’s records for a insurance or PBM company. I had a “flashbulb” moment in reading these words..
This “expert” is looking for clinical/objective evidence to justify the treatment for a SUBJECTIVE DISEASE. He/she is reading physician’s notes on a pt’s subjective disease issues… So those notes is the prescriber’s interpretation of what the pt stated as to their pain, the intensity of their pain, etc, etc… There is no objective means of measuring the pt’s intensity of pain and highly unlikely that the prescriber will adequately translate the pt’s body language into the pt’s medical record.
This is similar to two people exchanging emails, texts, messages and there is a misunderstanding by one side of the “conversation” because the conversation is basically a TWO DIMENSIONAL conversation… whereas, if the conversation had been in real time – face to face – and “body language” was part of the conversation… the misunderstanding may not have happened.
With the increased use of electronic medical records, is it time for prescribers to start recording the office visit of those pts dealing with subjective diseases and perhaps “forcing” those “experts” who are outsiders reviewing pt’s medical records to go past the typical two-dimensional pt chart reviews ?
I was right, I found out where this PharmD works https://www.welldynerx.com/
and from their website:
WellDyneRx took early steps to combat the opioid epidemic
In 2014, WellDyneRx clinicians decided they needed to take steps to curb opioid abuse. Through a multifaceted approach, members are managed via real-time cumulative morphine equivalent dose (MED) point-of-sale (POS) edits and prior authorizations for targeted high-risk medications.
EXPLAINS A LOT !!
Filed under: General Problems
Details are lacking when a provider types on a laptop. They don’t have the option to write detailed notes. Their attention is divided between typing and their patient. It is difficult to note what the patient says. As well as what the provider observes. This makes typed medical records not as reliable and complete as handwritten or dictated medical records.