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

基本信息

批准号：
8721382
负责人：
Joanna L. Starrels
金额：
$ 9.87万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
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/8721382
关键词：
Adult Agreement Analgesics Behavior Computerized Medical Record Contracts Data Development Plans Elements Epidemic Face Feedback Foundations Future Goals Intervention Interview Knowledge Learning Medical Medicine Mentored Patient-Oriented Research Career Development Award Mentors Minority Modeling Monitor Opioid Opioid Analgesics Outcome Overdose Pain Pain management Patients Pharmaceutical Preparations Phase Physicians Pilot Projects Planning Theory Primary Care Physician Primary Health Care Process Qualitative Research Recommendation Research Research Methodology Research Personnel Risk Risk Reduction Societies Source Specialist Specific qualifier value Structure Substance abuse problem Training United States Urine Writing addiction base career development chronic pain college drug testing evidence base health care delivery improved longitudinal analysis opioid misuse primary care setting professor research and development stem symposium theories therapy development

项目摘要

PROJECT SUMMARY 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.

项目摘要为了帮助阻止阿片类镇痛药的流行，成瘾和过量的专业痛苦社会监管机构建议医生实施阿片类药物治疗协议（OTA）来定义针对患者开出长期阿片类镇痛药的治疗和监测计划，以缓解慢性疼痛。尽管初级保健医生很少实施OTA，对他们的障碍和促进者知之甚少 OTA实施，或有关改善原始护理环境中OTA实施的干预措施。这项受过指导的注重患者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）发展一种理论指导的干预措施来促进在初级保健中实施OTA，（3）确定是否是否理论指导的干预措施与OTA实施初级保健的变化有关。实现这些目的，我们将使用以下理论对初级保健医生进行半结构化访谈计划行为作为理论框架的合理行动 /理论，以及一个示例OTA文档作为提示。根据我们的发现，我们将开发一种理论指导的干预措施，以促进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。我们期望干预将包括量身定制的OTA文档以及支持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，我们会的对两种大型城市初级保健实践的干预进行了为期12个月的试点研究。我们将进行使用电子病历数据进行的前验证分析以确定干预是否与 OTA文档或尿液药物测试的使用变化，这是监测策略的关键要素由OTA。从该提案中获得的知识将为未来的研究和质量改进提供信息在初级保健中促进负责任的阿片类药物处方的举措。候选人乔安娜·史塔雷斯（Joanna L. Starrels），医学博士，是艾伯特·爱因斯坦（Albert Einstein）医学院。她的长期目标是成为定义和促进的独立调查员基于循证的和负责任的阿片类药物处方策略，用于慢性疼痛的初级保健患者。她短期目标是获得专业知识：阿片类药物滥用疼痛管理，高级定性研究，改变医师行为的干预措施和纵向数据的分析。 Starrels博士组装了指导团队，包括全国领导人滥用药物，疼痛管理和医疗保健服务。