| One-Minute Clinician

The Ingredients of Better Treatment Planning

Medical recordkeeping has the potential to be reduced to checkboxes: I’ve done this, I’ve done that, I’m good with the people who will review my records, so I’m done. But I think integrating the information in a meaningful fashion is the next level that we’re trying to get clinicians to go to. So in addition to the pain complaint, they need to do a risk assessment, and know what those risk assessment tools are, but then also what impact that risk assessment level should have on their treatment planning.

Risk assessment information guides your monitoring level; how often are you going to have the patient come back, how often are you going to do a drug screen, how often are you going to do a pill count, how often are you going to check the pharmacy monitoring program of your state, all those things. For example, Medicare has now asked that clinicians do drug screening based on risk. You can’t just drug-screen somebody every session. You need to titrate it to risk.  Somebody that’s high risk, you might want to drug screen every time.  If somebody’s low risk, not so much. So it’s going to directly affect your monitoring processes. Risk also affects the types of medicines that you would choose for a patient. In general, with higher risk patients, the thinking is that you would select more long-acting, less abusable medications, lower dose quantities in terms of units. Risk might suggest going to a patch versus an oral formulation that’s more abusable. So it’s going to affect the types of medicines that you prescribe and also the amount that you’re going to prescribe.

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