Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial

经济学应用

• 批准号: 10017802
• 负责人: JASON N. DOCTOR
• 金额: $ 70.15万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017802
• 关键词: Accident and Emergency department; Adherence; Adult; Adverse event; Affect; American; Behavior; Behavioral; Benzodiazepines; Binding; CCL4 gene; California; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinic; Clinical; Cluster randomized trial; Country; Data; Dose; Dose-Rate; Economics; Education; Electronic Health Record; Event; Exposure to; Future; Goals; Guideline Adherence; Guidelines; Health system; Illinois; Intervention; Knowledge; Life; Motivation; Opioid; Oregon; Overdose; Pain; Pain management; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacotherapy; Phase; Poisoning; Population; Prevention Guidelines; Primary Health Care; Psyche structure; Psychology; Recommendation; Reporting; Safety; Social Psychology; Suggestion; Techniques; Testing; Text; Therapeutic; Treatment outcome; Urine; Visit; Work; base; behavioral economics; chronic pain; design; drug testing; expectation; improved; insight; morphine equivalent; non-cancer pain; non-opioid analgesic; novel; opioid exposure; opioid misuse; opioid overdose; opioid policy; opioid use; opioid use disorder; peer; prescription opioid; prevent; primary outcome; response; secondary outcome; social; tool; trial comparing; uptake

ABSTRACT There is a lack of evidence that long-term opioid use offers benefit for noncancer pain and an abundance of evidence of harm​. Last year, the Centers for Disease Control and Prevention (CDC) issued the “CDC Guideline for Prescribing Opioids for Chronic Pain” to encourage safe and effective alternatives to opioids, discontinuation of opioids when patients do not resume normal activities and prudent dosing strategies. However, poor guideline adherence is a general concern and may impede uptake. ​Our prior studies have used insights from behavioral economics and social psychology to increase guideline adherence. We propose to apply these techniques within the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial to improve adherence to the CDC and to the Oregon Pain Guidance pain management guideline. In the R21 phase, we will assess the feasibility of implementing the following candidate nudges: 1) Defaults (guideline concordant actions that take place when clinicians fail to act), 2) precommitments (advanced commitments by clinicians to guideline adherent behaviors that bind them to these behaviors in the future), 3) justifications (free-text responses entered by the clinician that explain why guidelines were not followed and which are recorded as a patient note in the electronic health record); these are triggered when defaults are removed and commitments are not honored, 4) peer comparisons (a type of socially motivated performance reporting) and 5) a nudge to increase the salience and availability of adverse opioid events. In the R33 phase, we will conduct the AESOPS trial, an 18-month cluster randomized trial. The trial is across 374 primary care clinics in the U.S. We compare three conditions: C1) Peer comparison and justification , C2) defaults, precommitments or available adverse events added to the C1 interventions, C3) education control. The primary outcomes is clinician aggregate monthly mg morphine equivalent (ME) for patients with ​>​50 mg ME daily dose. Secondary, outcomes are benzodiazepine co-prescribing and rate of dose escalation to ​>​50 mg ME/day. We anticipate that the AESOPS trial will provide new knowledge about how to improve adherence to the CDC Guideline for Prescribing Opioids for Chronic Pain and to concordant pain guidelines. The trial may also help us understand how to prevent future incidents of opioid use disorder and opioid poisoning death by lowering unnecessary population exposure to these drugs.

抽象的 缺乏证据表明长期使用阿片类药物为非癌症疼痛和一个 危害证据的抽象。去年，疾病控制与预防中心 （CDC）发布了“针对慢性疼痛开处方阿片类药物的CDC指南”，以鼓励安全 以及有效的烯型烯酸药物，当患者不恢复时停止卵子类药物 正常活动和审慎的给药策略。但是，依从性差是一般的 关注并可能阻碍吸收。我们先前的研究使用了行为的见解 经济学和社会心理学，以提高准则遵守。我们建议应用这些 经济学和社会心理学应用中的技术以改善阿片类药物 开处方安全（AESOPS）试验，以提高对CDC和俄勒冈州疼痛的依从性 指南疼痛管理指南。在R21阶段，我们将评估 实施以下候选人轻推：1）默认（指南一致的行动， 发生在临床医生不采取行动时发生）2）预定（临床医生的高级承诺 为了将来将它们与这些行为绑定到这些行为的指南遵守行为），3）理由 （临床医生输入的自由文本答复，解释了为什么不遵循准则，并且 这些记录是电子健康记录中的患者注释）；这些是触发的 删除默认值，未兑现承诺，4）同行比较（一种类型 具有社会动机的绩效报告）和5）轻推以提高显着性和 不良阿片类药物事件的可用性。在R33阶段，我们将进行AESOPS试验， 18个月的聚类随机试验。该试验在美国的374家初级保健诊所中 比较三个条件：C1）同行比较和理由，C2）默认，预定 或可用的不良事件添加到C1干预措施中，C3）教育控制。主要 结果是临床总计每月MG吗啡当量（ME），> 50 mg的患者 我每天剂量。次要结果是苯二氮卓类的共同处方和剂量速率 每天升级到50毫克我。我们预计AESOPS审判将提供新的知识 关于如何提高遵守CDC指南的慢性疼痛指南 以及一致的疼痛指南。审判也可能有助于我们了解如何防止未来 阿片类药物使用障碍和阿片类药物中毒死亡的事件通过降低不必要的人群 暴露于这些药物。