Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives.
Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives.
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DOI：
10.1186/s12913-021-07230-5
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发表时间：
2021-11-03
影响因子：
2.8
通讯作者：
Ranapurwala SI
中科院分区：
文献类型：
--
作者：
Blackburn NA;Joniak-Grant E;Nocera M;Dorris SW;Dasgupta N;Chelminski PR;Carey TS;Wu LT;Edwards DA;Marshall SW;Ranapurwala SI
最近增加的州法律，以减少阿片类药物处方已经表明，需要了解他们是如何解释和实施的医疗保健系统。本研究的目的是探索医院管理人员和处方人员用于实施2017年北卡罗来纳州加强阿片类药物预防（STOP）法案阿片类药物处方限制的系统，策略和资源，该法案将初始处方限制为5天（急性）或7天（手术后）供应。我们采访了14名医院管理人员和38名处方医生，他们拥有医学、护理、药学、工商管理和公共卫生学位，在北卡罗来纳州工作。访谈指南参考了实施研究综合框架，探讨了实施的障碍和促进因素。访谈主题包括沟通、资源和医院系统支持。访谈被记录和转录，然后使用灵活的编码进行分析，整合归纳和演绎编码，以告知分析代码的开发和识别主题。我们确定了三个主要主题，围绕实施STOP法案规定的处方限制：组织沟通，开处方者教育和电子病历（EMR）系统的变化。管理员在提高认识和提供提醒以促进处方者行为改变的背景下反思了实施情况，通过电子邮件和面对面沟通以及EMR变更专用资源进行操作。处方者指出，关于处方限制的行政沟通往往侧重于合法性，这表明该组织的政策指令，而不是被动的提醒。处方医生表示希望有更多的空间来回答他们的问题和资源，用于患者沟通。虽然医院管理人员将遵守法律视为优先事项，但处方医生反映了对充分管理患者疼痛和临床护理时间有限的担忧。医院管理者和处方者以不同的心态对待STOP法案处方限制的实施。当管理者专注于政策合规性时，处方者专注于患者的需求。然后，执行任务的战略必须平衡患者需求与政策合规性。随着各州继续立法以防止阿片类药物过量死亡，了解医疗保健系统和处方者如何实施法律将通过定制和最大化可用资源来提高其有效性。在线版本包含补充材料，可通过10.1186/s12913-021-07230-5获得。
Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and prescribers used to implement the 2017 North Carolina Strengthen Opioid Prevention (STOP) Act opioid prescribing limits, which limited initial prescriptions to a five (for acute) or seven (for post-surgical) days’ supply. We interviewed 14 hospital administrators and 38 prescribers with degrees in medicine, nursing, pharmacy, business administration and public health working across North Carolina. Interview guides, informed by the Consolidated Framework for Implementation Research, explored barriers and facilitators to implementation. Interview topics included communication, resources, and hospital system support. Interviews were recorded and transcribed, then analyzed using flexible coding, integrating inductive and deductive coding, to inform analytic code development and identify themes. We identified three main themes around implementation of STOP act mandated prescribing limits: organizational communication, prescriber education, and changes in the electronic medical record (EMR) systems. Administrators reflected on implementation in the context of raising awareness and providing reminders to facilitate changes in prescriber behavior, operationalized through email and in-person communications as well as dedicated resources to EMR changes. Prescribers noted administrative communications about prescribing limits often focused on legality, suggesting a directive of the organization’s policy rather than a passive reminder. Prescribers expressed a desire for more spaces to have their questions answered and resources for patient communications. While hospital administrators viewed compliance with the law as a priority, prescribers reflected on concerns for adequately managing their patients’ pain and limited time for clinical care. Hospital administrators and prescribers approached implementation of the STOP act prescribing limits with different mindsets. While administrators were focused on policy compliance, prescribers were focused on their patients’ needs. Strategies to implement the mandate then had to balance patient needs with policy compliance. As states continue to legislate to prevent opioid overdose deaths, understanding how laws are implemented by healthcare systems and prescribers will improve their effectiveness through tailoring and maximizing available resources. The online version contains supplementary material available at 10.1186/s12913-021-07230-5.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
--
作者：
Chayama, Koharu Loulou;McNeil, Ryan;Knight, Rod
通讯作者：
Knight, Rod
影响因子：
11.3
作者：
Hanailton, Alison B.;Finley, Erin P.
通讯作者：
Finley, Erin P.
影响因子：
3.1
作者：
Davis, Corey S.;Piper, Brian J.;Rotter, Jason S.
通讯作者：
Rotter, Jason S.
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R