Creating and Using a Patient Provider Agreement
Notes to Consider
It is important that opioid therapy be offered as part of a larger treatment plan that may encompass other, non-pharmacological interventions.
These may include:
- Regular exercise.
- Stress management techniques.
- Meditation.
- Physical Therapy.
- Cognitive-behavioral Therapy.
The treatment plan should also include a review of expectations, including:
- Regular attendance at all appointments.
- Pill counts.
- Urine drug testing.
- The use of only one provider and pharmacy to receive prescription medications.
- Refill and renewal policies.
Questions to Ask Patients
- Are you able to cook/clean/shop for yourself?
- Do you use assistive devices?
- Do you have help at home?
- Where do you live?
- Are you stably housed?
- Are there stairs to enter or within your home?
- Do you feel safe at home?
- Are you responsible for the care of children?
- Are you in a relationship?
- Do you feel safe in your relationship?
- Who is in your network of helpful/supportive people?
- How do you get around and to appointments?
- Is your income enough to meet your basic needs?
- Do you have a history of psychiatric hospitalization?
- Do you have a a history of suicidal ideation or attempts?
- Have you ever received mental health treatment?
- Are you currently receiving mental health treatment?
Substance Abuse
(street drugs, alcohol, Rx Medications)
- Do you have a history of substance abuse?
- Are you currently abusing any substances?
- Are you responsible for the care of children?
- What is the highest grade in school that you completed?
- Are you able to read and write?
- Have you ever been in jail or prison?
- Do you have any current legal issues?
- Do you belong to a church or other spiritual organization?
Sources
Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005 Mar-Apr;6(2):107-12.
Nicolaidis C. Police officer, deal-maker, or health care provider? Moving to a patient-centered framework for chronic opioid management. Pain Med 2011;12(6):890-897.
