Impacting the Prescribing of Opioids through Academic Detailing

1教育提供者适当处方阿片类药物的学术详细（AD）计划， 2改善健康结果和患者护理的潜力，但AD在多大程度上有效 三是不完善。建议研究的长期目标是改善 4例慢性疼痛患者，同时减少致命性和非致命性阿片类药物过量。这一目标将得以实现 5通过实施和评估提供给初级保健提供者的AD计划， 6慢性非癌性疼痛的治疗。目的是通过以下方式提高阿片类药物处方的适当性： 伊利诺伊州的7个初级保健提供者。中心假设是，一对一的广告访问的学术细节 8将改善初级保健提供者的适当阿片类药物处方，并加强他们对国家的使用 9处方药方案。拟议研究的基本原理植根于需要产生 10个关于AD计划改善阿片类药物处方并为患者提供资源的有效性的证据 11成功实施这项工作将通过建立在试点AD计划， 12芝加哥和伊利诺伊州南部地区，我们成功地实施了与国家的合作， 13伊利诺伊州PMP。这项拟议的研究将严格评估两种不同的AD计划的有效性， 14伊利诺伊州。具体目标是：1）评估AD计划的短期（6个月）影响， 对初级保健提供者的阿片类药物处方模式和PMP使用情况进行15次访问; 2）确定 16更持续的AD计划（即两次以上访视）的长期有效性（12个月）; 3） 17为反倾销方案开发一个在线工具包，提供关于安全和适当管理 18名慢性疼痛患者，供卫生系统和州/地方卫生部门使用。拟议 19项研究在阿片类药物处方的AD访视设计方面具有创新性，包括个体化阿片类药物 使用伊利诺伊州PMP数据比较供应商处方与当地规范的20个指标，使用经验证的措施， 21评估由于AD访视和计划评估而改变阿片类药物处方行为的意图 22采用阶梯楔形随机分组设计。我们在推行广告试验计划方面的成功经验 作为伊利诺伊州疾病预防控制中心预防各州活动和我们建立的关系的一部分， 24与伊利诺伊州PMP和整个伊利诺伊州的卫生系统使我们能够很好地评估 25关于阿片类药物处方活动的广告。拟议的研究对打击阿片类药物流行具有重要意义 26，因为支持反倾销计划及其设计和交付的有效性的证据对于 27确定修改处方行为和改善疼痛患者管理的方法。 28预期的结果是积极影响临床决策和病人的结果在伊利诺伊州和 29解决了AD计划有效性的证据差距，这些计划利用与州PMP的关系， 30改善医疗保健提供者的阿片类药物处方和疼痛管理。

1 Academic detailing (AD) programs that educate providers on the appropriate prescribing of opioids have the 2 potential to improve health outcomes and patient care, but the extent to which AD is effective for this purpose 3 is not well established. The long-term goal of the proposed research is to improve the management of 4 patients with chronic pain while reducing fatal and non-fatal opioid overdoses. This goal will be accomplished 5 by implementing and evaluating AD programs delivered to primary care providers on the appropriate 6 management of chronic non-cancer pain. The objective is to improve appropriateness of opioid prescribing by 7 primary care providers in Illinois. The central hypothesis is that one-on-one AD visits by academic detailers 8 will improve appropriate opioid prescribing by primary care providers and enhance their use of the State 9 Prescription Drug Program (PMP). The rationale for the proposed research is rooted in the need to generate 10 evidence on the effectiveness of AD programs to improve opioid prescribing and provide resources to 11 successfully implement them. This work will be accomplished by building on pilot AD programs in the 12 Chicagoland and Southern Illinois regions that we successfully implemented in collaboration with the State of 13 Illinois PMP. The proposed research will rigorously evaluate the effectiveness of two different AD programs in 14 Illinois. The specific aims are: 1) to evaluate the short-term (6 month) impact of an AD program involving 2 15 visits on opioid prescribing patterns and PMP utilization among primary care providers; 2) to determine the 16 longer-term effectiveness (12 months) of a more sustained AD program (i.e. more than two visits); 3) to 17 develop an online toolkit of accessible resources for AD programs on the safe and appropriate management of 18 patients with chronic pain for use by health-systems and state/local health departments. The proposed 19 research is innovative in the design of the AD visit on opioid prescribing, including individualized opioid 20 metrics that compare provider prescribing to local norms using Illinois PMP data, use of validated measures to 21 assess intention to change opioid prescribing behavior as a result of the AD visit, and program evaluation 22 using a stepped-wedge cluster-randomized design. Our successful experience in implementing pilot AD 23 programs in the state as part of Illinois' CDC prevention for states activities and our established relationship 24 with the Illinois PMP and health-systems throughout Illinois make us well positioned to evaluate the impact of 25 AD on opioid prescribing activities. The proposed research is significant to combating the opioid epidemic 26 because evidence to support the effectiveness of AD programs and their design and delivery is critical to 27 identifying approaches that modify prescribing behaviors and improve the management of patients with pain. 28 The expected outcome is to positively impact clinical decision-making and patient outcomes in Illinois and 29 address evidence gaps on the effectiveness of AD programs that leverage relationships with state PMPs to 30 improve opioid prescribing and pain management by healthcare providers.