Novel Opioid Safety Clinic Initiative to Deliver Guideline-Concordant Chronic Opioid Therapy in Primary Care.
Novel Opioid Safety Clinic Initiative to Deliver Guideline-Concordant Chronic Opioid Therapy in Primary Care.
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DOI：
10.1016/j.mayocpiqo.2018.09.005
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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：
Glanz, Jason M
中科院分区：
文献类型：
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作者：
Binswanger, Ingrid A;Joseph, Nicole;Glanz, Jason M
目的：开发和评估一种新的阿片类药物安全诊所（OSC）倡议，以加强对处方慢性阿片类药物治疗（COT）患者评估和监测指南的遵守。患者和方法：OSC是在一个城市联邦合格的健康中心开发的，为COT提供指导一致的护理，标准化工作流程，并有效地利用临床人员。我们使用匹配队列研究评估OSC。2014年7月1日至2016年3月31日共有539例患者参加了该诊所。其中，472名临床参与者与472名非参与者在OSC访问之日的性别和年龄相匹配。通过标准化疼痛评估、尿液毒理学和纳洛酮配药的完成率来评估OSC。我们对OSC参与者和非OSC参与者进行了逻辑回归比较。结果：共有539名患者参加了OSC访问，约占慢性阿片类药物登记患者的53%。OSC参与者比非参与者更有可能完成疼痛评估（调整优势比[aOR]， 169.8; 95% CI, 98.3-293.5），完成尿液毒理学（aOR, 46.1; 95% CI, 30.4-69.9），或在12个月的随访中分配纳洛酮（aOR, 2.8; 95% CI, 1.9-4.3）。结论：OSC模型提高了初级保健对指南一致性COT的依从性。未来的研究需要评估这些干预措施对疼痛、生活质量和阿片类镇痛药不良事件的影响。
OBJECTIVE: To develop and evaluate a novel Opioid Safety Clinic (OSC) initiative to enhance adherence to guidelines on the assessment and monitoring of patients prescribed chronic opioid therapy (COT).PATIENTS AND METHODS: The OSC was developed at an urban Federally Qualified Health Center to provide guideline-concordant care for COT, standardize workflows, and efficiently use clinic staff. We evaluated the OSC using a matched cohort study. Five hundred thirty-nine patients participated in the clinic between July 1, 2014, and March 31, 2016. Of these, 472 clinic participants were matched to 472 nonparticipants by sex and age on the date of the OSC visit. The OSC was evaluated by its completion rates of standardized pain assessments, urine toxicology, and naloxone dispensings. We conducted logistic regression comparing OSC participants to OSC nonparticipants.RESULTS: A total of 539 patients attended an OSC visit, representing approximately 53% of patients in the chronic opioid registry. The OSC participants were more likely than nonparticipants to have completed a pain assessment (adjusted odds ratio [aOR], 169.8; 95% CI, 98.3-293.5), completed a urine toxicology (aOR, 46.1; 95% CI, 30.4-69.9), or had naloxone dispensed (aOR, 2.8; 95% CI, 1.9-4.3) over 12 months of follow-up.CONCLUSION: The OSC model improved adherence to guideline-concordant COT in primary care. Future research is needed to assess the impact of these interventions on pain, quality of life, and adverse events from opioid analgesics.