Engaging clinicians to improve opioid safety and reduce overdose risk

让临床医生参与提高阿片类药物的安全性并降低过量风险

• 批准号: 10339306
• 负责人: Michael A. Fischer
• 金额: $ 76.91万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10339306
• 关键词: Engaging; clinicians; improve; opioid; safety

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.

抽象的 美国面临阿片类药物危机，阿片类药物的流行病率有关 服用过量。尽管使用和错过阿片类药物已经发生了几个世纪，但在过去20年中发生了变化 与这些药物相关的发病率和死亡率急剧增加。电流 危机始于处方阿片类药物被使用和过度使用，以使海洛因使用增加 以及相关的死亡率，最近转向使用合成阿片类药物（例如芬太尼）。 成功降低阿片类药物使用障碍和过量的速度将需要吸引前线临床医生 并为他们提供信息和技能，使他们俩都可以更安全地管理疼痛 避免过度使用阿片类药物，并建立诊断和治疗阿片类药物患者的能力 使用基于证据的方法的障碍。 我们的多学科项目团队将评估临床导向干预措施对阿片类药物的影响 开处方和过量相关的结果。研究建议与正在进行的CDC支持 俄勒冈州卫生管理局（OHA）的干预措施以及OHA提出的额外CDC资金 在未来三年中继续并扩大这些努力。 OHA干预措施将结合学术 细节（AD）和六个构件实践设施（PF）方法来支持实践 更改。实施将在俄勒冈州农村实践的研究网络中进行，并补充 根据俄勒冈州的其他实践，将涉及至少100个练习场。我们的项目团队包括 AD和六个构件的原始开发商接近，这将确保质量 评估的实施和相关性。 我们将评估AD和PF实施的忠诚度以及对实践和提供者的影响 有关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。我们将 建立现有工作以创建链接的数据集以进行分析，结合了状态处方的信息 药物监测计划，全付款人索赔数据库，应急系统，重要记录，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 分析将提供有关将这些干预措施适应过程和结果的见解 阿片类药物危机。我们将进一步测试链接数据集的潜在适应为通用数据模型 格式化，为未来的阿片类药物干预措施创造了机会。 研究结果将通过多种渠道（例如 会议上的演讲和研究文章的发表。提案PI指导国家 在RFA中确定的学术细节资源中心是信息，支持的重要来源 和技术援助，该平台将增强向更广泛的民族受众的翻译。