Are Opioid Dependence and Methadone Maintenance Treatment (MMT) Documented in the Medical Record? A Patient Safety Issue
- 115 Downloads
Opioid-dependent patients often have co-occurring chronic illnesses requiring medications that interact with methadone. Methadone maintenance treatment (MMT) is typically provided separately from medical care. Hence, coordination of medical care and substance use treatment is important to preserve patient safety.
To identify potential safety risks among MMT patients engaged in medical care by evaluating the frequency that opioid dependence and MMT documentation are missing in medical records and characterizing potential medication-methadone interactions.
Among patients from a methadone clinic who received primary care from an affiliated, but separate, medical center, we reviewed electronic medical records for documentation of methadone, opioid dependence, and potential drug-methadone interactions. The proportions of medical records without opioid dependence and methadone documentation were estimated and potential medication-methadone interactions were identified.
Among the study subjects (n = 84), opioid dependence documentation was missing from the medical record in 30% (95% CI, 20%–41%) and MMT documentation was missing from either the last primary care note or the last hospital discharge summary in 11% (95% CI, 5%-19%). Sixty-nine percent of the study subjects had at least 1 medication that potentially interacted with methadone; 19% had 3 or more potentially interacting medications.
Among patients receiving MMT and medical care at different sites, documentation of opioid dependence and MMT in the medical record occurs for the majority, but is missing in a substantial number of patients. Most of these patients are prescribed medications that potentially interact with methadone. This study highlights opportunities for improved coordination between medical care and MMT.
KEY WORDSmethadone medication interactions patient safety care coordination
The authors would like to thank Eileen Brigandi, Donna Beers, RN, and the staff at Substance Abuse Prevention and Treatment Services, Boston Public Health Commission, for their support and cooperation during this study. We would also like to thank Courtney Pierce for her assistance in manuscript preparation. This project was funded in part by the National Institute on Drug Abuse R25-DA13582. Parts of this work were presented at the Society of General Internal Medicine annual meeting, April 11, 2008; the College on Problems in Drug Dependence annual meeting, June 19, 2008; the Addiction Health Services Research conference, October 21, 2008; and the Association for Medical Education and Research in Substance Abuse annual meeting, November 8, 2008.
Conflict of Interest
- 1.Kohn LT, Corrigan JM, Donaldson MS. Committee on quality of health care in america, institute of medicine. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.Google Scholar
- 2.Joint Commission. 2008 National Patient Safety Goals. Available at: www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/. Accessed May 31, 2009.
- 3.Improving the quality of healthcare for mental and substance-use conditions. Institute of Medicine. 504. 2005. Washington, DC: The National Academy Press: 2005.Google Scholar
- 5.Bureau of National Affairs. Beckerman JZ, Pritts J, Goplerud E, Leifer J, Borzi PC, Rosenbaum S. Health information privacy, patient safety, and health care quality: Issues and challenges in the context of treatment for mental health and substance use.16. Available at: ihcrp.georgetown.edu/pdfs/pritts0208.pdf. Accessed May 31, 2009.Google Scholar
- 6.Confidentiality of Alcohol and Drug Abuse Patient Records. Code of Federal Regulations Title 42, Volume 1, Chapter 1, Part 2. Available at: http://www.access.gpo.gov/nara/cfr/waisidx_02/42cfr2_02.html. Accessed May 31, 2009.
- 22.Leavitt SB. Methadone-drug interactions. Addiction Treatment Forum - 3rd Edition 2005; November 2005: 1–31. Available at: www.atforum.com/SiteRoot/pages/addiction_resources/Drug_Interactions.pdf. Accessed May 31, 2009.
- 25.Velarde MC, Peino AJ, Gomez de Caso Canto JA. The Methadone Maintenance Program for intravenous heroin addicts. What information do primary care physicians have? Aten Primaria. 1996;17:581–4.Google Scholar