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Intervention to Promote Opioid Treatment Agreements in Primary Care

促进初级保健中阿片类药物治疗协议的干预措施

基本信息

批准号：
8144834
负责人：
Joanna L. Starrels
金额：
$ 18.13万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-30 至 2015-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8144834
关键词：
Adult Agreement Analgesics Behavior Computerized Medical Record Contracts Data Development Plans Elements Epidemic Face Feedback Foundations Future Goals Intervention Interview Knowledge Learning Medical Medicine Mentored Patient-Oriented Research Career Development Award Mentors Minority Modeling Monitor Opioid Opioid Analgesics Outcome Overdose Pain Pain management Patients Pharmaceutical Preparations Phase Physicians Pilot Projects Planning Theory Primary Care Physician Primary Health Care Process Qualitative Research Recommendation Research Research Methodology Research Personnel Risk Risk Reduction Societies Source Specialist Specific qualifier value Structure Substance abuse problem Training United States Urine Writing addiction base career development chronic pain college drug testing evidence base health care delivery improved longitudinal analysis opioid misuse primary care setting professor public health relevance research and development stem symposium theories therapy development

项目摘要

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.

描述（由申请人提供）：为了帮助遏制阿片类镇痛药滥用、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药物治疗协议（OTA），为长期服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。尽管初级保健医生很少实施 OTA，但人们对其实施 OTA 的障碍和促进因素或改善初级保健机构中 OTA 实施的干预措施知之甚少。本次以患者为导向的研究职业发展奖申请的具体目标是：(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 实施的变化相关。为了实现这些目标，我们将使用理性行动理论/计划行为理论作为理论框架，并使用示例 OTA 文档作为提示，对初级保健医生进行半结构化访谈。根据我们的研究结果，我们将开发一种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迭代反馈对其进行完善。我们预计干预措施将包括定制的 OTA 文件以及支持 OTA 实施的组件，包括由两部分组成的医生培训、参考指南和季度病例会议。最后，我们将对两个大型城市初级保健机构的干预措施进行为期 12 个月的试点研究。我们将使用电子病历数据进行事前分析，以确定干预措施是否与 OTA 文件或尿液药物检测的使用变化有关，这是 OTA 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、理学硕士，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研究者，为患有慢性疼痛的初级保健患者定义和推广基于证据的、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：疼痛管理中阿片类药物的滥用、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 博士组建了一支指导团队，其中包括药物滥用、疼痛管理和医疗保健领域的国家领导人。公共卫生相关性：美国面临处方止痛药滥用和过量的流行。医生与服用此类药物的慢性疼痛患者之间达成的治疗协议可能有助于减少滥用和过量用药。这项研究将确定医生使用治疗协议的障碍，并开发一种干预模型来促进和研究治疗协议在初级保健机构中的使用。