Primary care intervention to reduce prescription opioid overdoses

初级保健干预减少处方阿片类药物过量

• 批准号: 9145508
• 负责人: Amy S B Bohnert
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9145508
• 关键词: Address; Address; Adverse event; Adverse event; Afghanistan; Afghanistan; Alcohol consumption; Alcohol consumption; Alcohol or Other Drugs use; Alcohol or Other Drugs use; Analgesics; Attention; Attention; Behavior; Behavior; Behavior Therapy; Behavior Therapy; Behavioral; Behavioral; Caring; Caring; Cessation of life; Cessation of life; Clinic; Clinic; Cognitive; Cognitive; Complement; Complement; Conflict (Psychology); Conflict (Psychology); Controlled Study; Controlled Study; Data; Data; Dose; Dose; Elements; Elements; Emergency department visit; Emergency department visit; Ensure; Ensure; Future; Future; General Population; Health Personnel; Health Personnel; Healthcare Systems; Healthcare Systems; Injury; Injury; Intervention; Intervention; Iraq; Iraq; Knowledge; Knowledge; Location; Location; Measures; Measures; Mediator of activation protein; Mediator of activation protein; Mental Health; Mental Health; Modality; Modality; Morphine; Motivation; Motivation; Opioid; Opioid; Opioid Analgesics; Outcome; Outcome; Overdose; Overdose; Pain; Pain; Pain management; Pain management; Pain quality; Pain quality; Participant; Participant; Patient Care; Patient Self-Report; Patient Self-Report; Patients; Patients; Personal Satisfaction; Personal Satisfaction; Pharmaceutical Preparations; Pharmaceutical Preparations; Pharmacy facility; Pharmacy facility; Prescription opioid overdose; Preventive Intervention; Preventive Intervention; Primary Health Care; Primary Health Care; Provider; Provider; Public Health; Public Health; Randomized; Randomized; Randomized Controlled Trials; Randomized Controlled Trials; Records; Records; Recruitment Activity; Reporting; Reporting; Risk; Risk; Risk Behaviors; Risk Behaviors; Risk Reduction; Risk Reduction; Safety; Safety; Sedation procedure; Sedation procedure; Self Efficacy; Self Efficacy; Services; Services; United States; United States; Veterans; Veterans; Violence; Violent injury; adverse outcome; adverse outcome; behavior change; behavior change; behavioral health; behavioral health; brief intervention; brief intervention; care providers; chronic pain; chronic pain; coping; coping; evidence base; evidence base; follow-up; follow-up; health administration; health administration; improved; improved; intervention effect; intervention effect; morphine equivalent; opioid mortality; opioid overdose; opioid therapy; opioid use; opioid use; overdose death; overdose prevention; overdose prevention; overdose risk; pill; pill; pragmatic trial; pragmatic trial; prescription opioid; prescription opioid; prevent; prevent; recruit; therapy design; therapy design; treatment as usual; treatment as usual

 DESCRIPTION (provided by applicant): Reducing opioid pain medication-related adverse outcomes among patients prescribed opioids for pain is critical for ensuring safe and high quality pain care in the Veterans Health Administration (VHA). Overdose is one such adverse outcome; overdose has substantially increased over the past decade and is a highly significant concern for Veterans, VHA care providers, and other stakeholders. A number of VHA initiatives have sought to improve prescribing practices in an effort to address this problem. Concurrent strategies that reduce patient behaviors that increase overdose risk have the potential to complement these efforts, but have not been examined in a controlled study. Primary care is an ideal location for identifying patients prescribed opioids who are at risk for adverse outcomes. Recent initiatives, such as Primary Care Mental Health (PC-MH), have led to the integration of behavioral health providers into primary care and provide the opportunity to deliver behavioral interventions designed specifically to reduce risky opioid use. The purpose of the Prescription Opioid Safety Trial (POST) study is to conduct a randomized controlled trial of a brief intervention to reduce opioid overdose risk behaviors among VHA primary care patients receiving long-term opioid therapy. The intervention blends elements of motivational enhancement interventions for risky substance use and cognitive behavioral pain management interventions. This new intervention will be compared to an equal attention enhanced usual care condition, with both conditions delivered by PC-MH therapists. The study will recruit 450 patients with long-term opioid use who are currently prescribed opioid doses of 50 morphine-equivalent mg/day or greater (an indicator of elevated overdose risk) from primary care clinics at the VA Ann Arbor Healthcare System. The specific aims are: Aim 1) to examine if patients randomly assigned to a brief overdose prevention intervention report reduce

 描述（由申请人提供）： 减少服用阿片类药物治疗疼痛的患者中与阿片类药物相关的不良后果对于确保退伍军人健康管理局 (VHA) 的安全和高质量的疼痛护理至关重要。 药物过量就是此类不良后果之一，并且在过去十年中大幅增加。这是退伍军人、VHA 护理提供者和其他利益相关者高度关注的问题，许多 VHA 举措都在寻求改善处方实践，以努力解决这一问题，同时采取减少增加用药过量风险的行为的策略有可能补充这些问题。努力了，但是还没有初级保健是识别有不良后果风险的阿片类药物患者的理想场所，例如初级保健心理健康 (PC-MH)，已导致行为健康提供者的整合。处方阿片类药物安全试验 (POST) 研究的目的是进行一项随机对照试验，进行简短的干预，以减少 VHA 中阿片类药物过量的风险行为。接受长期阿片类药物治疗的初级保健患者。这种新的干预措施融合了针对危险物质使用的动机增强干预措施和认知行为疼痛管理干预措施，将与同等注意力增强的常规护理条件进行比较，这两种条件均由 PC-MH 治疗师提供。长期使用阿片类药物，目前从 VA Ann Arbor 医疗系统的初级保健诊所开出 50 吗啡当量毫克/天或更高剂量的阿片类药物（过量风险升高的指标）。 具体目标是： 目标 1)检查如果分配给患者进行简短的药物过量预防干预报告减少