Engaging clinicians to improve opioid safety and reduce overdose risk

摘要 美国面临阿片类药物危机，与之相关的阿片类药物死亡率也很高 服药过量。尽管阿片类药物的使用和误用已经发生了几个世纪，但过去20年的变化 导致与这些药物相关的发病率和死亡率急剧增加。海流 危机始于处方类阿片类药物被使用和过度使用来止痛，随后海洛因使用量增加 以及相关的死亡率，最近转向使用合成阿片类药物，如芬太尼。 要想成功地降低阿片类药物使用障碍和过量用药的比率，就需要让一线临床医生参与进来。 并为他们提供信息和技能，使他们能够在更安全的同时 避免过度使用阿片类药物，并建设其诊断和治疗阿片类药物使用患者的能力 使用循证方法治疗精神障碍。 我们的多学科项目团队将评估临床医生指导的干预对阿片类药物的影响 处方和过量用药相关的结果。该研究提案与正在进行的疾控中心支持的项目相匹配 俄勒冈州卫生局(OHA)的干预措施以及OHA提出的增加CDC资金的建议 在未来三年继续并扩大这些努力。OHA的干预措施将结合学术 细节(AD)和六个构建块实践便利化(PF)方法，以支持制定 改变。将在俄勒冈州基于农村实践的研究网络中实施，并补充 由俄勒冈州的其他做法，并将涉及至少100个练习点。我们的项目团队包括 AD和六个积木的原始开发商方法，这将确保质量 评价的执行情况和相关性。 我们将评估AD和PF实施的保真度，以及对实践和提供商的影响 阿片类药物处方和阿片类药物使用障碍治疗的知识、态度和行为。我们会 在现有工作的基础上创建用于分析的关联数据集，并结合来自州处方的信息 药物监测计划、所有付款人索赔数据库、紧急响应系统、生命记录、住院 数据和药物使用障碍治疗系统。这些独特的数据工具将允许混合方法 分析将提供对调整这些干预措施的过程和结果的洞察 阿片类药物危机。我们将进一步测试将关联数据集转换为通用数据模型的可能性 格式，为未来阿片类药物干预的跨州研究创造了机会。 研究成果将通过多种渠道迅速翻译和传播，例如 在会议上发表演讲和发表研究文章。提案派执导国家 学术细节资源中心，在RFA中被确定为重要的信息、支持、 和技术援助，这一平台将加强对更广泛的全国受众的翻译。

Abstract The United States faces an opioid crisis with an associated epidemic rate of death from opioid overdose. Although use and misuse of opioids has occurred for centuries, changes over the past 20 years have contributed to dramatic increases in the morbidity and mortality associated with these agents. The current crisis began with prescription opioids being used and overused for pain, followed by increases in heroin use and associated mortality, and most recently a shift to the use of synthetic opioids such as fentanyl. Successfully reducing the rates of opioid use disorder and overdose will require engaging front-line clinicians and providing them with the information and skills that will allow them both to manage pain more safely while avoiding over-use of opioids and also to build their capacity to diagnose and treat patients with opioid-use disorder using evidence-based approaches. Our multidisciplinary project team will evaluate the impact of clinician-directed interventions on opioid prescribing and overdose-related outcomes. The research proposal is paired with ongoing CDC-supported interventions by the Oregon Health Authority (OHA) and with a proposal from OHA for additional CDC funding to continue and expand those efforts over the next three years. The OHA interventions will combine academic detailing (AD) and the Six Building Blocks practice facilitation (PF) approach to support practices in making changes. Implementation will occur across the Oregon Rural Practice-based Research Network, supplemented by other practices in Oregon, and will involve a minimum of 100 practice sites. Our project team includes the original developers of both AD and the Six Building Blocks approach, which will ensure the quality of implementation and relevance of the evaluation. We will evaluate the fidelity of implementation of AD and PF and the impact on practices’ and providers’ knowledge, attitude, and behaviors regarding opioid prescribing and opioid use disorder treatment. We will build on existing work to create a linked dataset for analysis, combining information from the state prescription drug monitoring program, all-payer claims database, emergency response system, vital records, hospitalization data, and substance-use disorder treatment system. These unique data tools will allow for a mixed methods analysis that will provide insights into both the processes and outcomes of adapting these interventions for the opioid crisis. We will further test the potential adaptation of the linked data set into a common data model format, creating opportunities for cross-state research on opioid interventions in the future. Research findings will be rapidly translated and disseminated through multiple channels such as presentations at conferences and publication of research articles. The proposal PI directs the National Resource Center for Academic Detailing, identified in the RFA as an important source for information, support, and technical assistance, and this platform will enhance translation to a broader national audience.