Promoting the implementation of clinical guidelines for opioid prescribing in primary care using systems consultation

利用系统咨询促进初级保健中阿片类药物处方临床指南的实施

• 批准号: 10198891
• 负责人: Andrew Quanbeck
• 金额: $ 71.71万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198891
• 关键词: Academic Detailing; Address; Adoption; Affect; Cessation of life; Clinic; Clinical; Clinical Trials; Communities; Consensus; Consultations; Control Groups; Dose; Effectiveness; Evidence based practice; Goals; Grant; Guidelines; Health Personnel; Health Status; Health system; Healthcare; Individual; Intervention; Knowledge; Learning; Literature; Measures; Medical; Morphine; Names; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Patients; Pharmaceutical Preparations; Physicians; Pilot Projects; Primary Health Care; Process; Provider; Randomized; Recommendation; Research; Research Design; Research Personnel; Sequential Multiple Assignment Randomized Trial; System; Testing; Time; Training; Wisconsin; Work; base; clinical implementation; comparative effectiveness; contextual factors; cost; cost effectiveness; cost estimate; flexibility; follow-up; group intervention; implementation science; implementation strategy; improved; incremental cost-effectiveness; innovation; milligram; opioid epidemic; opioid mortality; opioid policy; opioid therapy; overdose death; overdose risk; peer coaching; prescription opioid; primary care setting; primary outcome; systematic review; tool; uptake; virtual

Project Summary/Abstract The prescription opioids crisis begs for a flexible but generalizable systems-level implementation strategy to widely improve prescribing practices. A consensus has emerged about safer prescribing practices, but determining how to implement needed changes remains a challenge. The proposed research will test an innovative way to implement that consensus, adaptive systems consultation. The research aims to identify which sequence and combination of implementation strategies works most effectively in promoting practice change in different primary care clinics. The research serves the long-term goal of learning how to optimize implementation strategies to promote evidence-based practice in primary care settings. This proposal builds on a pilot study that tested systems consultation in 4 primary care clinics, which found that systems consultation was feasible, acceptable, and effective in reducing patients’ average opioid dose (an outcome directly related to the risk of overdose death). The proposed research tests an adaptive version of the strategy tailored to different levels (health system, clinic, prescriber). The intervention starts with academic detailing, a systems- level strategy consisting of an expert-led training session plus distance-based follow-up. This strategy continues for 18 months and serves as the control condition. At 3 months, half of the clinics will be randomized to receive practice facilitation, a clinic-level strategy aimed at improving processes related to opioid prescribing. At 6 months, prescribers will be assessed for guideline concordance, and half of non-guideline concordant prescribers will be randomized to receive physician peer coaching, a prescriber-level strategy, in which a physician expert gives one-on-one advice to prescribers in managing their patients on long-term opioid therapy. These 3 strategies will be delivered in a sequential, multiple-assignment randomized trial to 38 clinics from 3 Wisconsin health systems. The study compares the effect on average morphine milligram dose of an adaptive systems consultation implementation strategy (the intervention group) vs. academic detailing alone (the control group). The study will answer questions about the comparative effectiveness of prominent implementation strategies (academic detailing, practice facilitation, and physician peer coaching) in a single, highly efficient study. The study also develops an assessment of the contextual factors that influence the effectiveness of different implementation strategies and estimates the costs of delivering 4 different sequences and combinations of implementation strategies. This study will advance implementation science by testing a multi-level implementation strategy that can be tailored to assess contextual factors influencing implementation. This fundamental knowledge could be used to help mitigate the opioid crisis and in optimizing the selection and deployment of implementation strategies used to promote the uptake of many proven but underused practices throughout healthcare.

项目摘要/摘要 处方阿片类药物危机乞求灵活但可推广的系统级实施策略 广泛改善处方实践。关于更安全的处方行为已经达成了共识，但 确定如何实施所需的变化仍然是一个挑战。拟议的研究将测试 实施共识，自适应系统咨询的创新方式。该研究旨在确定 实施策略的序列和组合最有效地促进实践 不同的初级保健诊所的变化。该研究实现了学习如何优化的长期目标 在初级保健环境中促进循证实践的实施策略。该提议建立在 一项试点研究，测试了4家初级保健诊所的系统咨询，发现系统咨询 可行，可接受且有效地减少患者的平均阿片类药物剂量（结果直接相关 出现过量死亡的风险）。拟议的研究测试了量身定制的策略的自适应版本 不同的水平（卫生系统，诊所，处方者）。干预措施始于学术细节，系统 - 由专家主导的培训课程以及基于距离的随访组成的级别策略。这个策略 持续18个月，作为控制条件。在3个月时，一半的诊所将被随机分配 为了获得实践设施，旨在改善与阿片类药物处方相关的流程的诊所级策略。 在6个月时，处方者将被评估以获得指南协和，而一半的非指南一致性 处方者将被随机接受身体同伴教练，这是一种处方级策略，其中 物理专家向保护者提供一对一的建议，以长期治疗其患者的阿片类药物 治疗。这三种策略将在连续的多重分配随机试验中交付给38个诊所 来自威斯康星州3个卫生系统。该研究比较了对平均吗啡毫克剂量的影响 自适应系统咨询实施策略（干预小组）与学术细节 （对照组）。该研究将回答有关突出有效性的问题 实施策略（学术细节，实践设施和身体同伴教练） 高效的研究。该研究还对影响的上下文因素进行了评估 不同实施策略的有效性，并估算提供4个不同序列的成本 和实施策略的组合。这项研究将通过测试 可以量身定制以评估影响上下文因素的多层次实施策略 执行。这种基本知识可用于帮助减轻阿片类药物危机并进行优化 用于促进许多经过验证的实施策略的选择和部署 整个医疗保健的实践不足。