CEO SUMMARY: Hospitals and health systems developing programs to manage patients on chronic opioid therapy (COT) are finding that an essential element of these programs is regular toxicology testing. In its role as the toxicology test provider for a health network in Indiana, AIT Laboratories of Denton, Texas, has found that COT patients improved their compliance with their physicians’ orders under a program of regular monitoring with urine-drug testing. Also, physicians become more consistent in following the program’s protocols with their patients.
Second of Two Parts
PATIENTS ON CHRONIC OPIOD THERAPY UNDERGO regular laboratory tests to verify that they are in compliance with physicians’ orders. Clinical laboratories that do such testing have an opportunity to help physicians, hospitals, and health systems to manage some portion of the 24-million Americans who are on chronic opioid therapy and need urine-drug testing to ensure that they are complying with physicians’ orders.
Since 2015, AIT Laboratories in Denton, Texas, has worked with Community Health Network of Indianapolis (CHN) to conduct such testing in CHN’s five hospitals and 60 primary care centers in Indiana. AIT’s role is to test CHN patients to ensure they are complying with the protocols CHN developed to monitor those patients on chronic opioid therapy (COT).
Clinical laboratory testing has an essential role in confirming that COT patients are complying with physicians’ orders and following the protocols to ensure their safety under opioid treatment.
In 2015, AIT Laboratories recognized that Community Health Network needed a comprehensive opioid-testing program for its patients on COT. At the time CHN was implementing monitoring protocols consistent with the recommendations of the federal Centers for Disease Control and Prevention, including toxicology testing.
Develop Pilot Opioid Program
“We understood that CHN needed a prescription drug monitoring program,” said Greg Blankenship, AIT Labs Senior Vice President of Operations. “We worked together to develop a pilot program.”
AIT was based in Indianapolis before being acquired by HealthTrackRx, a company in Denton that helps healthcare providers and health systems to ensure appropriate use of opioids and antibiotics.
“We talked with CHN about what their providers needed in terms of monitoring patients on prescription drugs,” explained Blankenship. “From there, we figured out what we could do to help, including urine-drug testing and testing for other substances. With our tests we look for the presence of up to 30 drug classes or the equivalent of up to 125 drug analytes, depending on the physician’s lab test orders.” The lab has a staff of 260 employees, and all of its tests are run using mass spectroscopy.
AIT and CHN worked out a protocol in which HealthTrackRx staff would collect specimens in CHN’s five hospitals and in some of CHN’s 200 physicians’ offices in Indiana. CHN pays for the HealthTrackRx staff to collect those specimens. The expected turnaround time for results is within 24 hours of when specimens arrive at AIT’s lab, Blankenship said.
In addition, AIT provides quarterly reports to CHN on how the urine-drug testing program is helping the health system manage patient compliance.
Compliance with Protocols
“For example, CHN wants to ensure that their doctors and their patients are adhering to their protocols,” Blankenship explained. “CHN wants to identify all patients who are not adhering to their prescription orders, meaning those patients who are deviating.
“CHN also wants to know the percentages of physicians who are in compliance with the program’s protocols,” he added. “We work with CHN to spot aspects of the COT patient management program that may need additional attention.
“For example, if our data on test utilization and test results show a discrepancy between what’s expected and what’s happening, it gives CHN the information necessary to address that discrepancy with physicians and their patients,” he noted.
“Early analyses of our data indicate that both patients and physicians are getting better at meeting CHN’s COT program goals,” Blankenship commented.
“Our evaluation of the data shows that, once patients are monitored with regular toxicology testing, there is improvement in their compliance,” he added. “We also see an improvement because physicians are paying attention to compliance.”
In addition to testing for drugs of abuse, AIT also does specimen-validity testing. This is to ensure that patients are not trying to use adulterants or substitutes for their own urine in an effort to fool the urine-drug test.
Lessons Learned from Tox-Testing Program
GREG BLANKENSHIP HAS ADVICE FOR CLINICAL LABORATORIES seeking to develop urine-drug testing programs for hospitals and health systems managing some of the 24-million Americans on chronic opioid therapy.
As the senior vice president of operations for AIT Laboratories, Blankenship suggested that labs should understand the urine-drug testing protocols for patients on COT in each state. AIT has toxicology testing programs in 37 states.
“The first thing any lab would need to do is to become aware of the guidelines in each state, county, city, or town,” said Blankenship. “Also, there are guidelines from the Centers for Disease Control and Prevention.
“Once a lab learns what the guidelines are for prescribing and monitoring patients, then labs need to analyze how they help physicians, hospitals, and other providers with patient monitoring,” he said. “To do that, labs need to develop testing menus and turnaround times to help providers follow their own testing protocols and to help health systems enforce those protocols.
“Labs can help physicians, hospitals, and other providers through good reporting and educating providers on how to interpret the test results,” he added. “Many labs provide too little support today. That creates an opening for us to come in with best practices for this kind of testing and compliance monitoring.”
Contact Greg Blankenship, 940-383-2223 or email@example.com.