Intervention to Promote Opioid Treatment Agreements in Primary Care

描述（由申请人提供）：为了帮助阻止阿片类镇痛药滥用、成瘾和过量的流行，专业疼痛协会和监管机构建议医生实施阿片类治疗协议（ota），为长期使用阿片类镇痛药治疗慢性疼痛的患者制定治疗和监测计划。虽然初级保健医生很少实施在线旅行社，但人们对他们实施在线旅行社的障碍和促进因素知之甚少，也不了解在初级保健机构中改善在线旅行社实施的干预措施。这项以指导患者为导向的研究职业发展奖申请的具体目的是：(1)确定初级保健医生实施OTA的障碍和促进因素；(2)制定理论指导的干预措施，以促进初级保健中OTA的实施；(3)确定理论指导的干预措施是否与初级保健中OTA实施的变化有关。为了实现这些目标，我们将使用理性行为理论/计划行为理论作为理论框架，并以一个示例OTA文件作为提示，对初级保健医生进行半结构化访谈。基于我们的研究结果，我们将开发一个理论指导的干预措施来促进OTA的实施，然后通过预测试和初级保健医生的反复反馈来完善它。我们期望干预措施将包括定制的OTA文件以及支持OTA实施的组件，包括两部分的医生培训、参考指南和季度病例会议。最后，我们将在两个大型城市初级保健实践中进行为期12个月的干预试点研究。我们将使用电子病历数据进行前后分析，以确定干预措施是否与在线旅行社文件或尿检使用的变化有关，尿检是在线旅行社定义的监测策略的关键要素。从该提案中获得的知识将为未来的研究和质量改进举措提供信息，以促进初级保健中负责任的阿片类药物处方。候选人Joanna L. Starrels，医学博士，硕士，是阿尔伯特·爱因斯坦医学院的医学助理教授。她的长期目标是成为一名独立的研究者，为慢性疼痛的初级保健患者制定和促进循证和负责任的阿片类药物处方策略。她的短期目标是获得以下方面的专业知识：疼痛管理中的阿片类药物滥用，高级定性研究，改变医生行为的干预措施，以及纵向数据分析。Starrels博士组建了一个指导团队，其中包括药物滥用、疼痛管理和医疗保健服务方面的国家领导人。

DESCRIPTION (provided by applicant): To help stem the epidemic of opioid analgesic misuse, addiction, and overdose, professional pain societies and regulatory agencies recommend that physicians implement opioid treatment agreements (OTAs) to define treatment and monitoring plans for patients prescribed long-term opioid analgesics for chronic pain. Though primary care physicians infrequently implement OTAs, little is known about their barriers to and facilitators of OTA implementation or about interventions to improve OTA implementation in primary care settings. The specific aims of this Mentored Patient-Oriented Research Career Development Award application are: (1) to identify barriers to and facilitators of OTA implementation among primary care physicians, (2) to develop a theory-guided intervention to promote OTA implementation in primary care, and (3) to determine whether a theory-guided intervention is associated with changes in OTA implementation in primary care. To achieve these aims, we will conduct semi-structured interviews with primary care physicians using the Theory of Reasoned Action / Theory of Planned Behavior as a theoretical framework, and an example OTA document as a prompt. Based on our findings, we will develop a theory-guided intervention to promote OTA implementation, and then refine it through pretesting and iterative feedback from primary care physicians. We expect that the intervention will include a tailored OTA document as well as components that support OTA implementation, including a two-part physician training, a reference guide, and quarterly case conferences. Finally, we will conduct a 12-month pilot study of the intervention in two large urban primary care practices. We will conduct pre-post analyses using electronic medical record data to determine whether the intervention is associated with changes in the use of OTA documents or urine drug testing, a key element of the monitoring strategy defined by OTAs. The knowledge gained from this proposal will inform future research and quality improvement initiatives to promote responsible opioid prescribing in primary care. The candidate, Joanna L. Starrels, MD, MS, is an Assistant Professor of Medicine at Albert Einstein College of Medicine. Her long-term goal is to become an independent investigator in defining and promoting evidence-based and responsible opioid prescribing strategies for primary care patients with chronic pain. Her short-term goals are to gain expertise in: opioid misuse in pain management, advanced qualitative research, interventions to change physician behavior, and analysis of longitudinal data. Dr. Starrels has assembled a mentoring team that includes national leaders in substance abuse, pain management, and health care delivery. PUBLIC HEALTH RELEVANCE: The United States faces an epidemic of prescription pain killer abuse and overdose. Treatment agreements between physicians and their chronic pain patients who are prescribed such drugs may help to reduce abuse and overdose. This study will identify physicians' barriers to using treatment agreements and develop a model intervention to promote and study the use of treatment agreements in primary care settings.