A panel management approach using prescription drug monitoring program data for primary care patients with chronic pain treated with opioids: a feasibility study

van Eeghen et al. BMC Primary Care (2025) 26:371 https://doi.org/10.1186/s12875-025-03070-y BMC Primary Care Open Access RESEARCH A panel management approach using prescription drug monitoring program data for primary care patients with chronic pain treated with opioids: a feasibility study Constance van Eeghen1*, Marianne Burke1, Zoe Daudier2, Amanda G. Kennedy1, Neil Korsen3, Benjamin Littenberg1, Moira Mulligan1, Doug Pomeroy1, Jennifer Raymond2, Meagan E. Stabler2 and Charles D. MacLean1 Abstract Background This feasibility study explored a process for primary care clinicians to improve chronic pain management related to opioid prescribing practices by using state-based Prescription Drug Monitoring Program (PDMP) data to create panel management reports on patients receiving long term opioid therapy. Methods Conducted across four rural primary care clinics in Northern New England, the study assessed the feasibility of downloading and utilizing PDMP data and the perceived value of panel management reports derived from both PDMP and electronic health record (EHR) data in the care of patients with chronic pain treated with opioids for more than one year. Results The study found that downloading PDMP data was feasible and efficient across all sites. However, EHR review proved more challenging due to inconsistencies in data entry and the unstructured nature of some relevant data fields. Clinicians generally found PDMP data easy to generate and the panel management reports informative and useful for understanding opioid prescribing trends and identifying high-risk patients. Conclusions The findings suggest that while PDMPs are a potential source for panel management reports for patients with chronic pain who are treated with opioids, further study is needed to determine the effectiveness of such efforts to improve care for and safety of patients treated with opioids. Keywords Primary Care, Chronic pain, Opioid, Drug prescription, Panel management *Correspondence: Constance van Eeghen 1 Department of Medicine, Robert M. Larner College of Medicine, University of Vermont, C415 University of Vermont, 89 Beaumont Avenue, Given 4th Floor, Burlington, VT 05405, USA 2 Northern New England CO-OP Practice and Community-Based Research Network, Department of Community and Family Medicine, Dartmouth Health, 1 Medical Center Drive, Lebanon, NH 03756, USA 3 Center for Interdisciplinary Population and Health Research, MaineHealth 1 Riverfront Plaza, Fourth Floor, Westbrook, ME 04092, USA © The Author(s) 2025. 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To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Eeghen van et al. BMC Primary Care (2025) 26:371 Background The most common symptom encountered in primary care is pain [1], making primary care clinicians (PCCs) the de facto pain management service in the U.S. With PCCs writing half of all opioid prescriptions and writing a higher proportion of long-term opioid prescriptions [2, 3], they are the primary managers of a treatment that may lead to opioid use disorder (OUD) and its associated complications, including death. For 30 years, the U.S. population has experienced increased opioid use partly due to prescribed opioids. Although opioid prescribing has declined since 2010 [4], opioid-related deaths have increased in the U.S to 32.6 deaths per 100,000 standard population in 2022, recently decreasing to 31.3 in 2023 [5]. The 29% annual increase of deaths from 2020–2021 was likely due to the availability of illicit synthetic opioids (e.g., fentanyl [6]), lack of compliance by insurers in coverage of care for substance use disorder, barriers to accessing evidence-based treatment, and other secular trends [7]. Opioid prescribing continues to be of interest as current trends show primary care physicians are decreasing opioid prescribing at a decreasing rate (leveling off ) while advanced practice primary care clinicians are increasing their prescribing [8]. Treating chronic pain with opioids is challenging. Long-term prescribing is associated with many patient characteristics, including age at initiation (adults aged 18–25 years according to some sources; older adults in others), low socioeconomic status, and poor physical and mental health [9, 10]. Predictors of prescription opioid misuse for patients with chronic pain are complex, involving multiple psychosocial and mental health factors [11]. In 2021, 3.1% of the population aged 12 years or older (almost 9 million people) reported that they misused prescription pain relievers (primarily but not solely opioids) [12]. Most often, they sought relief from physical pain. Healthcare clinicians are caught between underaddressing patients’ pain and over-prescribing a potentially addictive substance. Even a five-day course of opioids is associated with a 10% probability of long-term opioid use one year later [13], rising to 27.3% for longacting opioids. Tramadol, promoted as safer than traditional opioids in avoiding addiction, is associated with a one-year probability of long-term use of 13.7% [11]. Although national guidance exists for opioid treatment of chronic, non-cancer pain [14], there is evidence of divergence between prescribing practice and clinical recommendations for a variety of reasons [15], including “inherited” patient panels from retiring PCC colleagues [16]. PCCs need data and tools to manage chronic pain appropriately, including opioid prescribing. They must optimize patient outcomes while also following Page 2 of 11 prescribing guidelines, state and local regulations, insurance requirements, and institutional policies. One strategy is “panel management,” which offers a systematic approach to the management of chronic illness [17–19]. Panel management is useful in managing chronic conditions such as diabetes mellitus and hypertension [18]. It is characterized by a set of tools and processes to identify patients and provide structured workflows based on evidence-based protocols, especially for those at high risk. Well-established models exist and they high (...truncated)