Multimodal Local Opioid Prescribing Intervention Outcomes in Chronic Noncancer Pain Management
Multimodal Local Opioid Prescribing Intervention Outcomes in Chronic Noncancer Pain Management
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DOI：
10.3122/jabfm.2019.04.180296
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发表时间：
2019-07-01
影响因子：
2.9
通讯作者：
Baumgardner, Dennis J.
中科院分区：
文献类型：
--
作者：
Arizmendez, Natalia P.;Kotovicz, Fabiana;Baumgardner, Dennis J.
背景：阿片类药物在美国的滥用使医生在治疗慢性非癌症疼痛(CNCP)方面面临挑战。我们实施了一项旨在促进安全阿片类药物处方实践的教育计划，希望提高与CNCP阿片类药物处方相关的适当性水平。方法：我们对在2个学术初级保健诊所连续至少90天使用CNCP阿片类药物的成年患者进行了质量改进研究，并进行了回顾性图表回顾。在基线(2014年7月至2015年5月)和初步干预之后(2016年1月至2016年6月；即在2015年6月至2015年12月实施适当阿片类药物处方的多式教育活动之后)对患者进行审查。根据9个项目的文献资料计算阿片类药物适宜性评分。分类变量采用Fisher精确检验，连续变量采用两样本t检验和回归分析。采用二元Logistic回归进行多变量建模。采用Mann-Whitney检验比较干预前后的适宜性评分。结果：共有177名患者在基线时和96名患者在干预后进行评估。患者的人口统计特征在统计学上没有不同。总体而言，干预后的适当性水平与干预前有显著差异(P<；.0001)，均值从干预前的5.54上升到干预后的6.29。两个诊所均较基线有显著改善(P值均<0.05)。结论：在治疗CNCP的同时，临床医生对最佳做法的教育与阿片类药物使用适当性的增加有关。
Background: Opioid misuse in the United States has made it challenging for physicians to treat chronic noncancer pain (CNCP). We implemented an educational program aimed at promoting safe opioid prescribing practices in hopes of increasing the level of appropriateness associated with prescribing opioids for CNCP.Methods: We conducted a quality-improvement study with a retrospective chart review of adult patients who were prescribed opioids for CNCP for at least 90 consecutive days at 2 academic primary care clinics. Patients were reviewed at baseline (July 2014-May 2015) and after initial interventions (January 2016-June 2016; ie, following multimodal educational activities on appropriate opioid prescription implemented from June 2015-December 2015). An opioid appropriateness score was calculated based on documentation of 9 items. Categorical variables were analyzed with Fisher exact tests and continuous variables by 2-sample t tests and regression analysis. Binary logistic regression was used for multivariable modeling. Mann-Whitney test was used to compare appropriateness scores before and after intervention.Results: A total of 177 and 96 patients were evaluated at baseline and postintervention, respectively. Patient demographic characteristics were not statistically different. Overall, postintervention level of appropriateness was significantly different from preintervention (P < .0001), with means increasing from 5.54 preintervention to 6.29 postintervention. Both clinics had significant improvement from baseline (both P values < . 003).Conclusions: Clinician education on best practices while treating CNCP is associated with an increase in the level of opioid use appropriateness.