Primary care intervention to reduce prescription opioid overdoses

 描述（由申请人提供）： 减少阿片类药物治疗疼痛的患者中与阿片类药物相关的不良结局对于确保退伍军人健康管理局（VHA）的安全和高质量疼痛护理至关重要。药物过量就是这样一种不良后果;在过去十年中，药物过量大幅增加，是退伍军人、VHA护理提供者和其他利益相关者非常关注的问题。一些VHA倡议试图改善处方实践，以解决这个问题。减少增加过量风险的患者行为的并行策略有可能补充这些努力，但尚未在对照研究中进行检查。初级保健是识别有不良后果风险的阿片类药物患者的理想场所。最近的举措，如初级保健心理健康（PC-MH），已导致行为健康提供者融入初级保健，并提供机会提供专门设计的行为干预措施，以减少危险的阿片类药物使用。 处方阿片类药物安全性试验（POST）研究的目的是在接受长期阿片类药物治疗的VHA初级保健患者中进行一项简短干预的随机对照试验，以减少阿片类药物过量的风险行为。该干预措施融合了针对危险物质使用的动机增强干预措施和认知行为疼痛管理干预措施的要素。这种新的干预措施将与同等关注的常规护理条件进行比较，这两种条件都由PC-MH治疗师提供。该研究将从VA安阿伯医疗保健系统的初级保健诊所招募450名长期使用阿片类药物的患者，这些患者目前的阿片类药物剂量为50吗啡当量mg/天或更高（过量用药风险升高的指标）。具体目的是：目的1）检查患者是否随机分配到一个简短的过量预防干预报告减少

 DESCRIPTION (provided by applicant): Reducing opioid pain medication-related adverse outcomes among patients prescribed opioids for pain is critical for ensuring safe and high quality pain care in the Veterans Health Administration (VHA). Overdose is one such adverse outcome; overdose has substantially increased over the past decade and is a highly significant concern for Veterans, VHA care providers, and other stakeholders. A number of VHA initiatives have sought to improve prescribing practices in an effort to address this problem. Concurrent strategies that reduce patient behaviors that increase overdose risk have the potential to complement these efforts, but have not been examined in a controlled study. Primary care is an ideal location for identifying patients prescribed opioids who are at risk for adverse outcomes. Recent initiatives, such as Primary Care Mental Health (PC-MH), have led to the integration of behavioral health providers into primary care and provide the opportunity to deliver behavioral interventions designed specifically to reduce risky opioid use. The purpose of the Prescription Opioid Safety Trial (POST) study is to conduct a randomized controlled trial of a brief intervention to reduce opioid overdose risk behaviors among VHA primary care patients receiving long-term opioid therapy. The intervention blends elements of motivational enhancement interventions for risky substance use and cognitive behavioral pain management interventions. This new intervention will be compared to an equal attention enhanced usual care condition, with both conditions delivered by PC-MH therapists. The study will recruit 450 patients with long-term opioid use who are currently prescribed opioid doses of 50 morphine-equivalent mg/day or greater (an indicator of elevated overdose risk) from primary care clinics at the VA Ann Arbor Healthcare System. The specific aims are: Aim 1) to examine if patients randomly assigned to a brief overdose prevention intervention report reduce