Provider Detailing: An Intervention to Decrease Prescription Opioid Deaths in Utah
Provider Detailing: An Intervention to Decrease Prescription Opioid Deaths in Utah
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DOI：
10.1111/j.1526-4637.2011.01125.x
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发表时间：
2011-01-01
期刊：
影响因子：
3.1
通讯作者：
Bateman, Kim
中科院分区：
文献类型：
--
作者：
Cochella, Susan;Bateman, Kim
背景。犹他州采取了多管齐下的努力，扭转服用处方阿片类药物的患者死亡流行的趋势。本文描述了提供者详细说明部分工作的方法。制定了强调六种推荐处方做法的演示文稿并将其提交给卫生保健工作者。鼓励参与者利用州处方数据库并完成一系列调查，评估演示后 0、1 和 6 个月的信心和行为变化。继续医学教育学分激励参与。结果。计划实施后，犹他州 2008 年与药物过量相关的死亡人数比 2007 年下降了 14.0%。在 46 场演讲中，共有 581 名医生和众多非医生卫生保健工作者参加了会议。 0 个月时有 366 名参与者、1 个月时有 82 名参与者、6 个月时有 29 名参与者完成了有关实践变革采用程度的跟踪调查。所有三项评估的综合结果显示，60-80% 的响应提供者表示不再开出长效阿片类药物来治疗急性疼痛或与镇静剂一起使用； 50% 的受访者指出在患者护理期间使用犹他州的受控物质数据库，并采用较低的起始剂量和较慢的升级速度； 30-50% 的受访者表示，他们获得了适当患者的心电图和睡眠研究，使用患者教育工具，并实施了犹他州的处方指南。结论。提供者详细信息与犹他州处方阿片类药物死亡率的降低和提供者自我报告的处方行为的改善有关。其他同时采取的干预措施可能有助于死亡率下降。这种干预的效果受到短期资金的限制。
Background. Utah undertook a multipronged effort to reverse an epidemic of deaths among patients taking prescription opioids. This article describes the provider detailing portion of the effort.Methods. Presentations highlighting six recommended prescribing practices were developed and presented to health care workers. Participants were encouraged to utilize the state prescription database and to complete a series of surveys assessing confidence and behavior changes at 0, 1, and 6 months post-presentation. Continuing medical education credits incentivized participation.Results. Utah's medication-related overdose deaths dropped 14.0% in 2008 compared with 2007 following program implementation. A total of 581 physicians and numerous nonphysician health care workers were reached during 46 presentations. Follow-up surveys regarding the degree of adoption of practice changes were completed by 366 participants at 0 months, 82 participants at 1 month, and 29 participants at 6 months. Combined results for all three evaluations showed that 60-80% of responding providers reported no longer prescribing long-acting opioids for acute pain or with sedatives; 50% noted using Utah's controlled substances database during patient care and utilizing lower starting doses and slower escalations; and 30-50% reported obtaining EKGs and sleep studies on appropriate patients, using patient education tools, and implementing Utah's prescribing guidelines.Conclusions. Provider detailing was associated with a decrease in Utah's prescription opioid death rate and improvements in provider self-reported prescribing behaviors. Other simultaneous interventions may have contributed to the decline in death rates. This intervention's effect was limited by short-term funding.