Implementing Opioid Risk Reduction Strategies into Primary Care Practice

在初级保健实践中实施阿片类药物风险降低策略

基本信息

批准号：
8675819
负责人：
JANE M LIEBSCHUTZ
金额：
$ 53.4万
依托单位：
BOSTON MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-07-15 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8675819
关键词：
Academic Detailing Address Adherence Adopted Affect Agreement Alcohol or Other Drugs use Asthma Behavior Boston Caring Chronic Chronic Disease Clinical Community Health Centers Computerized Medical Record Computers Cost Analysis Data Diabetes Mellitus Diagnosis Education Effectiveness of Interventions Electronics Elements Enrollment Ensure Feedback Funding Guideline Adherence Guidelines Health Professional Health Resources Health Services Administration Healthcare Home environment Individual Intervention Low Income Population Medical Mental Depression Mental Health Modeling Monitor Nurses Nursing Care Management Opiate Addiction Opioid Opioid Analgesics Outcome Outcome Measure Overdose Pain Pain management Patient Care Patients Performance Pharmaceutical Preparations Pharmacy facility Physicians Play Practice Guidelines Primary Health Care Process Provider Public Health Qualifying Randomized Randomized Controlled Trials Registries Relative (related person)Research Personnel Risk Risk Factors Risk Reduction Role Services Substance Use Disorder System Testing Time Training Urine Visit addiction base care systems chronic care model chronic pain clinical research site disease registry drug testing health disparity high risk improved instrument non-cancer pain novel opioid abuse opioid misuse outreach patient oriented patient population patient safety pill point of care population based prescription opioid primary care setting primary outcome programs public health relevance safety net tool

项目摘要

DESCRIPTION (provided by applicant): Prescription opioid misuse is a significant public health problem as well as a patient safety concern. Primary care providers (PCPs) are the leading prescribers of opioids for chronic pain, yet few providers follow standard practice guidelines regarding assessment and monitoring. We propose a novel system change in delivery of primary care services to decrease misuse of and addiction to prescription opioids for patients with chronic pain. We will build on the Chronic Care Model, primary care system change to implement guidelines for chronic disease (e.g. diabetes, depression) and ultimately, to improve patient outcomes. Our proposed intervention includes a nurse-managed registry for planning individual patient care and conducting population- based care for a population of patients receiving opioids for chronic pain. We will refine tools within the electronic medical record to facilitate guideline adherence. These tools include validated instruments to screen for active substance use, depression and to assess pain and function, and will prompt clinicians to order urine drug tests. Finally, academic detailing to clinicians is another effective way to improve care. In these visits, trained individuals visit clinicians where they practice and provid them with information to change practice. The information given may also assist PCPs in overcoming obstacles to change. We will evaluate implementation strategies to integrate the best available evidence for managing patients receiving chronic opioid therapy for chronic pain into primary care settings. We propose a randomized controlled trial in 4 Boston federally qualified community health centers (CHCs). We chose to conduct the study at CHCs that could become a model for care at other CHCs as their roles expand to cover many millions of low-income populations under the Affordable Care Act. Further, CHCs are in the vanguard of clinical sites adopting the patient centered medical home. We will randomize 56 PCPs to one of the two following conditions: intervention (nurse care management, registry, electronic decision support tools, and academic detailing) or control condition (electronic decision support tools). We will follow patients and providers in both conditions for 12 months after the initiation of the intervention. Our primary outcomes are PCP adherence to chronic opioid therapy guidelines and opioid misuse among patients.

描述（由申请人提供）：处方阿片类药物滥用是一个重大的公共卫生问题以及患者安全问题。初级保健提供者 (PCP) 是治疗慢性疼痛的阿片类药物的主要处方者，但很少有提供者遵循有关评估和监测的标准实践指南。我们建议对初级保健服务的提供进行新的系统变革，以减少慢性疼痛患者对处方阿片类药物的滥用和成瘾。我们将在慢性病护理模式、初级保健系统变革的基础上实施慢性病（例如糖尿病、抑郁症）指南，并最终改善患者的治疗结果。我们提出的干预措施包括由护士管理的登记处，用于规划个体患者护理，并对接受阿片类药物治疗慢性疼痛的患者群体进行基于人群的护理。我们将完善电子病历中的工具，以促进指南的遵守。这些工具包括经过验证的仪器，用于筛查活性物质使用、抑郁症以及评估疼痛和功能，并将提示临床医生进行尿液药物测试。最后，向临床医生提供学术详细信息是改善护理的另一种有效方法。在这些访问中，经过培训的人员会访问临床医生的执业地点，并向他们提供改变实践的信息。所提供的信息还可以帮助 PCP 克服变革的障碍。我们将评估实施策略，将管理接受慢性阿片类药物治疗慢性疼痛的患者的最佳现有证据整合到初级保健机构中。我们建议在 4 个波士顿联邦合格社区健康中心 (CHC) 进行随机对照试验。我们选择在 CHC 进行这项研究，随着其他 CHC 的作用扩大到覆盖《平价医疗法案》下的数百万低收入人群，该研究可能成为其他 CHC 的护理模式。此外，CHC 是采用以患者为中心的医疗之家的临床机构的先锋。我们将 56 名 PCP 随机分配到以下两个条件之一：干预（护理管理、登记、电子决策支持工具和学术细节）或控制条件（电子决策支持工具）。我们将在干预开始后对这两种情况的患者和提供者进行 12 个月的跟踪。我们的主要结果是 PCP 遵守慢性阿片类药物治疗指南以及患者滥用阿片类药物。