Primary Care Clinic Re-Design for Prescription Opioid Management
Primary Care Clinic Re-Design for Prescription Opioid Management
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DOI：
10.3122/jabfm.2017.01.160183
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发表时间：
2017-01-01
影响因子：
2.9
通讯作者：
Wagner, Ed H.
中科院分区：
文献类型：
--
作者：
Parchman, Michael L.;Von Korff, Michael;Wagner, Ed H.
背景资料：在美国，应对处方阿片类药物过度使用的挑战不成比例地落在了初级保健诊所的环境中。在这里，我们描述了一个框架，包括6个积木，以指导在此设置的努力，以解决使用阿片类药物治疗慢性pain.Methods：调查人员进行了实地考察，以30个初级保健诊所在美国各地选择他们使用的团队为基础的劳动力创新。现场访问包括与领导层的访谈、诊所图尔斯参观、观察诊所流程和团队会议，以及与工作人员和临床医生的访谈。对数据进行了审查，以确定围绕慢性阿片类药物治疗（COT）管理的临床系统变化的共同属性。这些概念进行了审查，以发展的叙述性描述的关键组成部分的变化，以提高COT use.Results：二十的30个网站已经解决了COT处方的改进。在这些研究中心中，确定了一组常见的6个构建模块：1）提供领导支持; 2）修订和调整诊所政策、患者协议（合同）和工作流程; 3）实施登记跟踪系统; 4）进行计划的、以患者为中心的访视; 5）为复杂患者确定资源; 6）衡量实现诊所目标的进展。常见的组成部分，诊所的政策，病人的协议和数据跟踪登记册，以评估progresses.Conclusions：在应对处方阿片类药物的过度使用和由此产生的流行病过量和成瘾，初级保健诊所正在作出改进驱动的一套共同的最佳实践，解决复杂的挑战，管理COT患者在初级保健环境。
Background: The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain.Methods: Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations. Site visits included interviews with leadership, clinic tours, observations of clinic processes and team meetings, and interviews with staff and clinicians. Data were reviewed to identify common attributes of clinic system changes around chronic opioid therapy (COT) management. These concepts were reviewed to develop narrative descriptions of key components of changes made to improve COT use.Results: Twenty of the thirty sites had addressed improvements in COT prescribing. Across these sites a common set of 6 Building Blocks were identified: 1) providing leadership support; 2) revising and aligning clinic policies, patient agreements (contracts) and workflows; 3) implementing a registry tracking system; 4) conducting planned, patient-centered visits; 5) identifying resources for complex patients; and 6) measuring progress toward achieving clinic objectives. Common components of clinic policies, patient agreements and data tracked in registries to assess progress are described.Conclusions: In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing COT patients in primary care settings.