Engaging clinicians to improve opioid safety and reduce overdose risk

摘要 美国面临阿片类药物危机，阿片类药物死亡率上升 服药过量虽然阿片类药物的使用和滥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。当前 危机开始于处方阿片类药物的使用和过度使用，其次是海洛因使用的增加 和相关的死亡率，以及最近转向使用合成阿片类药物，如芬太尼。 成功降低阿片类药物使用障碍和过量的发生率将需要一线临床医生的参与 并为他们提供信息和技能，使他们能够更安全地管理疼痛， 避免过度使用类阿片，并建设其诊断和治疗类阿片使用患者的能力 使用循证医学的方法。 我们的多学科项目团队将评估临床医生指导的干预措施对阿片类药物的影响。 处方和过量相关的结果。该研究提案与正在进行的CDC支持的 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干预措施将联合收割机学术 详细说明（AD）和六个构建块实践促进（PF）方法来支持制定实践 变化实施将发生在整个俄勒冈州农村实践为基础的研究网络，补充 由其他做法在俄勒冈州，并将涉及至少100个实践地点。我们的项目团队包括 这将确保建筑物的质量， 评价的实施和相关性。 我们将评估AD和PF实施的保真度以及对实践和提供者的影响。 关于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 在现有工作的基础上，结合来自州规定的信息，创建一个用于分析的链接数据集 药品监测计划、所有付款人索赔数据库、应急响应系统、生命记录、住院 数据和物质使用障碍治疗系统。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见解， 鸦片危机我们将进一步测试链接数据集到公共数据模型中的潜在适应性 格式，创造机会，跨国家研究阿片类药物干预措施在未来。 研究结果将通过多种渠道迅速翻译和传播， 在会议上发言和发表研究文章。提案PI指示国家 学术细节资源中心，在RFA中被确定为信息，支持， 这一平台将加强向更广泛的国家受众的翻译。

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.