A Model for Improving Adherence to Prescribing Guidelines for Chronic Opioid Therapy in Rural Primary Care.
A Model for Improving Adherence to Prescribing Guidelines for Chronic Opioid Therapy in Rural Primary Care.
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DOI：
10.1016/j.mayocpiqo.2018.09.004
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发表时间：
2018-12-01
期刊：
影响因子：
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通讯作者：
Abu Dabrh, Abd Moain
中科院分区：
文献类型：
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作者：
Witt, Terrence J;Deyo-Svendsen, Mark E;Abu Dabrh, Abd Moain
目的：描述农村初级保健实践有效实施阿片类药物处方guidelines.Patients和方法：2014年12月1日至2017年5月30日，进行了一项质量改进项目。要素包括处方登记，护士协调员和阿片类药物使用审查小组。重新设计了诊所工作流程，以更一致地将这些和其他指南建议纳入实践。阿片类药物处方的影响进行了测量，以及患者outcomes.RESULTS：有462例患者符合纳入标准前实施。在研究结束时，16名患者（3%）死亡，9名患者（2%）不再接受参与该项目的临床医生的治疗，2名患者（0.4%）已过渡到临终关怀或长期护理机构。在其余435例患者中，96例（22.1%; 95% CI，18.4-26.2）的处方减少至入选阈值以下或不再接受阿片类药物处方。最初，64例患者（13.9%; 95% CI，11.0-17.3）使用的平均每日剂量等于或大于90毫克吗啡当量。实施后，54 435例（12.4%; 95%CI，9.6-15.8）仍然使用等于或大于90吗啡毫克当量每天占死亡或损失后follow-up.CONCLUSION：在临床过程中的变化，以实施长期阿片类药物治疗处方指南完成。这与使用慢性阿片类药物治疗的患者数量减少有关，主要是在较低剂量下。这是在农村实践中完成的，在疼痛医学，精神病学和成瘾医学方面的资源非常有限。
OBJECTIVE: To describe the steps taken and results obtained by a rural primary care practice to effectively implement opioid prescribing guidelines.PATIENTS AND METHODS: Between December 1, 2014, and May 30, 2017, a quality improvement project was undertaken. Elements included prescribing registries, a nurse coordinator, and an Opioid Use Review Panel. Clinic workflow was redesigned to more consistently incorporate these and other guideline recommendations into practice. The effect on opioid prescribing was measured as well as patient outcomes.RESULTS: There were 462 patients meeting inclusion criteria before implementation. At the conclusion, 16 patients (3%) had died, 9 patients (2%) were no longer seeing clinicians participating in the project, and 2 patients (0.4%) had transitioned to hospice or long-term care facilities. Of the remaining 435 patients, 96 (22.1%; 95% CI, 18.4-26.2) had decreased prescribing below the threshold for inclusion or were no longer receiving opioid prescriptions. Originally, 64 patients (13.9%; 95% CI, 11.0-17.3) were using average daily doses equal to or greater than 90 morphine milligram equivalents. After implementation, 54 of 435 patients (12.4%; 95% CI, 9.6-15.8) were still using equal to or greater than 90 morphine milligram equivalents per day after accounting for death or loss to follow-up.CONCLUSION: A change in clinic process to implement guidelines for prescribing of chronic opioid therapy was completed. It was associated with a decrease in the number of patients using chronic opioid therapy, primarily at lower doses. This was accomplished in a rural practice with very limited resources in pain medicine, psychiatry, and addiction medicine.