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药物治疗协议（OTA），为长期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OTA，很少有人知道他们的障碍和促进OTA的实施或干预措施，以改善OTA的实施在初级保健环境。 该指导性患者导向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，以促进初级保健中的OTA实施，以及（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，并以OTA文件为提示，与初级保健医生进行半结构化访谈。根据我们的研究结果，我们将制定一个理论指导的干预措施，以促进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。我们预计，干预措施将包括量身定制的OTA文件以及支持OTA实施的组件，包括两部分医生培训，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，以确定干预是否与OTA文件使用或尿液药物检测的变化有关，这是OTA定义的监控策略的关键要素。从该提案中获得的知识将为未来的研究和质量改进计划提供信息，以促进初级保健中负责任的阿片类药物处方。 候选人乔安娜·L. Starrels，MD，MS，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，为患有慢性疼痛的初级保健患者定义和推广基于证据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：阿片类药物滥用在疼痛管理，先进的定性研究，干预措施，以改变医生的行为，和纵向数据的分析。Starrels博士组建了一个指导小组，其中包括药物滥用，疼痛管理和医疗保健提供方面的国家领导人。 公共卫生相关性：美国面临着处方止痛药滥用和过量的流行病。医生与慢性疼痛患者之间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，并制定一个模型干预，以促进和研究在初级保健环境中使用治疗协议。

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.