Primary care intervention to reduce prescription opioid overdoses

 描述(由申请人提供)： 在服用阿片类止痛药的患者中，减少与阿片类止痛药物相关的不良后果，对于确保退伍军人健康管理局(VHA)安全和高质量的疼痛护理至关重要。过量用药就是这种不良后果之一；在过去十年中，过量用药大幅增加，是退伍军人、VHA护理提供者和其他利益攸关方非常关注的问题。VHA的一些举措试图改善处方做法，以努力解决这一问题。减少增加过量用药风险的患者行为的同时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处方阿片类药物患者的理想地点。最近的举措，如初级保健精神健康(PC-MH)，导致行为保健提供者纳入初级保健，并提供了提供专门为减少危险的阿片类药物使用而设计的行为干预的机会。处方阿片类药物安全试验(POST)研究的目的是进行一项随机对照试验，对接受长期阿片类药物治疗的VHA初级保健患者进行短暂干预，以减少阿片类药物过量的危险行为。该干预措施混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。这一新的干预措施将与同等关注的增强型常规护理条件进行比较，这两种情况都由PC-MH治疗师提供。这项研究将从VA Ann Arbor Healthcare System的初级保健诊所招募450名长期使用阿片类药物的患者，他们目前从VA Ann Arbor Healthcare System的初级保健诊所获得相当于50毫克吗啡或更高剂量(过量风险的指标)的阿片类药物处方。具体目标是：目的1)检查随机分配到简短的过量用药预防干预报告的患者是否减少

 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