Collaboration & Consistency Are Keys to Better Prescribing Practices

<img src="doctor.gif" alt="Rhea MacDonald Nova Scotia">

Dr. Rhea MacDonald and her colleagues designed the “Inverness Model” which has successfully and drastically reduced the excessive prescribing of monitored drugs in that community and is catching on across the country.

Dr. Rhea MacDonald, a family physician in Inverness, Cape Breton was uncomfortable with her own opioid prescribing practices and felt she had to make some changes to deliver better care and to prescribe more responsibly.

She learned that six of her physician colleagues had similar worries, and they decided to tackle the problem together.

In collaboration with other care providers, the local RCMP detachment and the community pharmacy, the physicians developed a series of new policies consistent with the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. The policies included a patient opioid agreement for all patients prescribed opioids, random urine drug screening, replacing short-acting opioids with long-acting ones when possible, and pill counts.

Dr. MacDonald and her colleagues expected that implementing the new policies would be difficult, and planned accordingly, but the implementation went smoothly.

“We have open conversations with our patients,” says Dr. MacDonald. “We present a united front, we aren’t targeting specific people and we continue to treat pain – but we treat it differently than we did previously,” says Dr. MacDonald.

“I am not my patient’s friend, I am their doctor and I must prescribe responsibly,” she says.

Dr. MacDonald and her colleagues hope their model – known as “The Inverness Model” – will be implemented in other communities.

“Kids are dying across this country every day from accidental opioid overdose, and it has to stop,” says Dr. MacDonald. “Prescribers need to recognize their role in this problem and also realize there is something we can do about it.”

“I have never thought of myself as a leader,” says Dr. MacDonald. “I just saw a problem, and with my team, developed a comprehensive program to address this problem.”

“Learning that I can be responsible for implementing change is humbling and mind-blowing at the same time,” she says.

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Submitted By: Ruth Skinner

As a retired health care provider,I have watched the consequences of over prescribing and overuse of opioids for some time.Thank you to Dr. MacDonald and her colleagues for taking the initiative to help correct this very serious problem.

Submitted By: Carla Callegari

Does your model consider medical marijuana as an option instead of opioids? What is your opinion of the current process for patients to access marijuana?

Submitted By: Doctors Nova Scotia

Hello Carla,

Thank you for your comment. To answer your question, we do not consider medical marijuana as an alternative to opioids. In fact, I do not know of any evidence to suggest otherwise.
Medical marijuana is prescribed for patients based on the physician’s comfort level with it. Doctors Nova Scotia is concerned about the lack of evidence to support the efficacy of medical marijuana as well as the need for education for physicians who choose to prescribe. Learn more about our position here.

Dr. Rhea MacDonald

(Posted by Doctors Nova Scotia on behalf of Dr. Rhea MacDonald.)

Submitted By: Larry MacLean

I really know nothing of health care but to see this fine Doctor collaborate with others including her patients is very simple but very remarkable in today’s age .Dr.MacDonald you truly have started a great step and that’s how things get done.Thank you for caring.You must be a very wonderful Doctor!I really wish you all the best and btw Merry Christmas and Happy New Year to you and yours.