Intervention to Promote Opioid Treatment Agreements in Primary Care

促进初级保健中阿片类药物治疗协议的干预措施

• 批准号: 8046594
• 负责人: Joanna L. Starrels
• 金额: $ 18.15万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8046594
• 关键词: Intervention; Promote; Opioid; Treatment; Agreements

DESCRIPTION (provided by applicant): To help stem the epidemic of opioid analgesic misuse, addiction, and overdose, professional pain societies and regulatory agencies recommend that physicians implement opioid treatment agreements (OTAs) to define treatment and monitoring plans for patients prescribed long-term opioid analgesics for chronic pain. Though primary care physicians infrequently implement OTAs, little is known about their barriers to and facilitators of OTA implementation or about interventions to improve OTA implementation in primary care settings. The specific aims of this Mentored Patient-Oriented Research Career Development Award application are: (1) to identify barriers to and facilitators of OTA implementation among primary care physicians, (2) to develop a theory-guided intervention to promote OTA implementation in primary care, and (3) to determine whether a theory-guided intervention is associated with changes in OTA implementation in primary care. To achieve these aims, we will conduct semi-structured interviews with primary care physicians using the Theory of Reasoned Action / Theory of Planned Behavior as a theoretical framework, and an example OTA document as a prompt. Based on our findings, we will develop a theory-guided intervention to promote OTA implementation, and then refine it through pretesting and iterative feedback from primary care physicians. We expect that the intervention will include a tailored OTA document as well as components that support OTA implementation, including a two-part physician training, a reference guide, and quarterly case conferences. Finally, we will conduct a 12-month pilot study of the intervention in two large urban primary care practices. We will conduct pre-post analyses using electronic medical record data to determine whether the intervention is associated with changes in the use of OTA documents or urine drug testing, a key element of the monitoring strategy defined by OTAs. The knowledge gained from this proposal will inform future research and quality improvement initiatives to promote responsible opioid prescribing in primary care. The candidate, Joanna L. Starrels, MD, MS, is an Assistant Professor of Medicine at Albert Einstein College of Medicine. Her long-term goal is to become an independent investigator in defining and promoting evidence-based and responsible opioid prescribing strategies for primary care patients with chronic pain. Her short-term goals are to gain expertise in: opioid misuse in pain management, advanced qualitative research, interventions to change physician behavior, and analysis of longitudinal data. Dr. Starrels has assembled a mentoring team that includes national leaders in substance abuse, pain management, and health care delivery. PUBLIC HEALTH RELEVANCE: The United States faces an epidemic of prescription pain killer abuse and overdose. Treatment agreements between physicians and their chronic pain patients who are prescribed such drugs may help to reduce abuse and overdose. This study will identify physicians' barriers to using treatment agreements and develop a model intervention to promote and study the use of treatment agreements in primary care settings.

描述（由申请人提供）：为了帮助阻止阿片类镇痛药的流行，成瘾，过量服用，专业疼痛社会和监管机构建议医师实施阿片类药物治疗协议（OTA），以定义治疗和监测患者的长期阿片类法痛药的治疗计划。尽管初级保健医生很少会实施OTA，但对OTA实施的障碍和促进者或有关改善初级保健环境中OTA实施的干预措施的障碍知之甚少。 这项受过指导的以患者为导向的研究职业发展奖的具体目的是：（1）确定基层医生OTA实施的障碍和促进者，（2）开发一种理论指导的干预措施以促进基层医疗中的OTA实施，（3）确定理论导致的干预措施是否与OTA实施中的OTA实施变化有关。为了实现这些目标，我们将使用计划行为的理论 /计划行为理论作为理论框架，对初级保健医师进行半结构化访谈，并提示OTA文件示例。根据我们的发现，我们将开发一种理论引导的干预措施来促进OTA实施，然后通过初级保健医生的预测试和迭代反馈来完善它。我们预计干预措施将包括量身定制的OTA文件以及支持OTA实施的组件，包括两部分的医师培训，参考指南和季度案例会议。最后，我们将对两种大型城市初级保健实践的干预措施进行12个月的试点研究。我们将使用电子医疗记录数据进行预先分析，以确定干预措施是否与OTA文档使用或尿液药物测试的变化有关，这是OTA定义的监测策略的关键要素。从该提案中获得的知识将为未来的研究和质量改进计划提供信息，以促进初级保健中负责任的阿片类药物处方。 候选人，医学博士Joanna L. Starrels是Albert Einstein医学院的医学助理教授。她的长期目标是成为定义和促进基于循证和负责任的阿片类药物处方策略的独立研究者，以针对慢性疼痛的初级保健患者制定策略。她的短期目标是获得专业知识：疼痛管理中的阿片类药物滥用，高级定性研究，改变医师行为的干预措施以及对纵向数据的分析。 Starrels博士组建了一个指导团队，其中包括滥用药物，疼痛管理和医疗保健服务的国家领导人。 公共卫生相关性：美国面临着处方止痛药滥用和过量的流行。处方这种药物的医生与其慢性疼痛患者之间的治疗协议可能有助于减少滥用和过量。这项研究将确定医生使用治疗协议的障碍，并制定模型干预措施，以促进和研究在初级保健环境中使用治疗协议的使用。