Engaging clinicians to improve opioid safety and reduce overdose risk

让临床医生参与提高阿片类药物的安全性并降低过量风险

• 批准号: 9909144
• 负责人: Michael A. Fischer
• 金额: $ 76.91万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9909144
• 关键词: Engaging; clinicians; improve; opioid; safety

Abstract The United States faces an opioid crisis with an associated epidemic rate of death from opioid overdose. Although use and misuse of opioids has occurred for centuries, changes over the past 20 years have contributed to dramatic increases in the morbidity and mortality associated with these agents. The current crisis began with prescription opioids being used and overused for pain, followed by increases in heroin use and associated mortality, and most recently a shift to the use of synthetic opioids such as fentanyl. Successfully reducing the rates of opioid use disorder and overdose will require engaging front-line clinicians and providing them with the information and skills that will allow them both to manage pain more safely while avoiding over-use of opioids and also to build their capacity to diagnose and treat patients with opioid-use disorder using evidence-based approaches. Our multidisciplinary project team will evaluate the impact of clinician-directed interventions on opioid prescribing and overdose-related outcomes. The research proposal is paired with ongoing CDC-supported interventions by the Oregon Health Authority (OHA) and with a proposal from OHA for additional CDC funding to continue and expand those efforts over the next three years. The OHA interventions will combine academic detailing (AD) and the Six Building Blocks practice facilitation (PF) approach to support practices in making changes. Implementation will occur across the Oregon Rural Practice-based Research Network, supplemented by other practices in Oregon, and will involve a minimum of 100 practice sites. Our project team includes the original developers of both AD and the Six Building Blocks approach, which will ensure the quality of implementation and relevance of the evaluation. We will evaluate the fidelity of implementation of AD and PF and the impact on practices’ and providers’ knowledge, attitude, and behaviors regarding opioid prescribing and opioid use disorder treatment. We will build on existing work to create a linked dataset for analysis, combining information from the state prescription drug monitoring program, all-payer claims database, emergency response system, vital records, hospitalization data, and substance-use disorder treatment system. These unique data tools will allow for a mixed methods analysis that will provide insights into both the processes and outcomes of adapting these interventions for the opioid crisis. We will further test the potential adaptation of the linked data set into a common data model format, creating opportunities for cross-state research on opioid interventions in the future. Research findings will be rapidly translated and disseminated through multiple channels such as presentations at conferences and publication of research articles. The proposal PI directs the National Resource Center for Academic Detailing, identified in the RFA as an important source for information, support, and technical assistance, and this platform will enhance translation to a broader national audience.

抽象的 美国面临阿片类药物危机以及与阿片类药物相关的流行病死亡率 尽管阿片类药物的使用和滥用已经发生了几个世纪，但过去 20 年发生了变化。 导致与这些药物相关的发病率和死亡率急剧增加。 危机始于处方阿片类药物的使用和过度用于止痛，随后海洛因使用量增加 和相关的死亡率，以及最近转向使用合成阿片类药物，如芬太尼。 成功降低阿片类药物使用障碍和过量服用率需要一线战士的参与 并为他们提供信息和技能，使他们能够更安全地管理疼痛，同时 避免过度使用阿片类药物，并建立诊断和治疗阿片类药物使用患者的能力 使用基于证据的方法来治疗疾病。 我们的多学科项目团队将评估临床医生指导的干预措施对阿片类药物的影响 该研究提案与疾病预防控制中心正在进行的支持相结合。 俄勒冈州卫生局 (OHA) 的干预措施以及 OHA 提出的额外 CDC 资金提案 为了在未来三年内继续并扩大这些努力，OHA 的干预措施将与学术相结合。 详细说明（AD）和六大模块实践促进（PF）方法来支持实践 变化将在俄勒冈州基于农村实践的研究网络中实施，并予以补充。 俄勒冈州的其他实践，并将涉及至少 100 个实践地点，我们的项目团队包括 AD 和六大构建模块方法的原始开发人员，这将确保 评价的实施和相关性。 我们将评估 AD 和 PF 实施的保真度以及对实践和提供商的影响 有关阿片类药物处方和阿片类药物使用障碍治疗的知识、态度和行为。 以现有工作为基础，创建用于分析的链接数据集，结合来自州处方的信息 药物监测计划、全付款人索赔数据库、应急响应系统、重要记录、住院治疗 数据和药物滥用障碍治疗系统这些独特的数据工具将允许采用混合方法。 分析将提供对适应这些干预措施的过程和结果的见解 我们将进一步测试链接数据集对通用数据模型的潜在适应性。 格式，为未来阿片类药物干预的跨州研究创造机会。 研究成果将通过多种渠道快速转化和传播，例如 提案 PI 指导国家会议的演讲和研究文章的出版。 学术细节资源中心，在 RFA 中被确定为信息、支持、 和技术援助，该平台将加强向更广泛的全国受众的翻译。