Toward safer opioid prescribing for chronic pain in high risk populations: implementing the Centers for Disease Control Guideline (CDC) guideline in the primary care HIV clinic

为高危人群的慢性疼痛提供更安全的阿片类药物处方：在初级保健 HIV 诊所实施疾病控制中心 (CDC) 指南

• 批准号: 9753158
• 负责人: Jessica Robinson-Papp
• 金额: $ 48.68万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9753158
• 关键词: Toward; safer; opioid; prescribing; chronic

Project Summary/Abstract In March 2016, the Centers for Disease Control issued a guideline (CDCG) for prescribing opioids for chronic pain in general primary care settings, which was intended to reduce prescription opioid-related harms while maintaining pain control and function. However, due to a paucity of data on the effectiveness of prescription opioid risk mitigation strategies, ambiguity in some of the CDCG recommendations, and the challenging nature of the patient-provider opioid conversation, the success of the CDCG may hinge on the manner in which it is implemented in individual care settings. In this proposal, we have chosen to focus on the HIV primary care setting for which we will develop a tailored, algorithmic “testable” version of the CDCG (“CDCG intervention”), and then pilot it in a randomized-controlled feasibility study. The development process will involve collaboration with stakeholders. First we will elicit recommendations from 50 HIV-infected individuals using a process of Public Deliberation. Next we will collaborate with an advisory board of HIV healthcare providers to use these recommendations to develop and iteratively refine the CDCG intervention. For the feasibility study, we will randomize and train 10 HIV primary care providers (PCPs) to provide the CDCG intervention or usual care to consenting patients (~5 per PCP) to whom they already prescribe opioids for chronic pain. The intervention will be provided for 6 months during which time patient-participants will be monitored for signs of opioid misuse, and changes in pain control, antiretroviral adherence, and their relationship with their provider. Multiple aspects of feasibility will be examined, including but not limited to: recruitment and randomization of PCPs, maintenance of intervention fidelity for the duration of the study, appropriateness of the control arm, and appropriateness of the outcome measures. The results of the study will be the basis for a future large, randomized controlled trial which will provide evidence for the effectiveness of the CDCG intervention in improving prescription opioid safety in the HIV primary care setting, and will also provide insights into how the CDCG might best be implemented in other settings.

项目概要/摘要 2016 年 3 月，美国疾病控制中心发布了阿片类药物治疗慢性病的指南 (CDCG) 一般初级保健机构中的疼痛，旨在减少处方阿片类药物相关的危害，同时 维持疼痛控制和功能。然而，由于缺乏处方有效性的数据 阿片类药物风险缓解策略、CDCG 一些建议的模糊性以及挑战性 就患者与提供者阿片类药物对话而言，CDCG 的成功可能取决于其对话的方式 在个人护理环境中实施。在本提案中，我们选择重点关注艾滋病毒初级保健 我们将为此开发一个定制的、算法“可测试”版本的CDCG（“CDCG干预”）， 然后在随机对照可行性研究中进行试点。 开发过程将涉及与利益相关者的合作。首先我们将引出建议 通过公共审议程序从 50 名 HIV 感染者中选出。接下来我们将与 HIV 医疗保健提供者咨询委员会使用这些建议来开发和迭代完善 美国CDCG干预。为了进行可行性研究，我们将随机分配并培训 10 名艾滋病毒初级保健提供者 (PCP) 向同意的患者（每个 PCP 约 5 名）提供CDCG 干预或常规护理 已经开阿片类药物治疗慢性疼痛。干预将持续 6 个月，在此期间 将监测患者参与者是否有阿片类药物滥用的迹象以及疼痛控制、抗逆转录病毒药物的变化 遵守情况以及他们与提供者的关系。将审查可行性的多个方面，包括 但不限于：PCP 的招募和随机化、维持干预期间的保真度 研究的内容、对照组的适当性以及结果测量的适当性。 该研究的结果将成为未来大型随机对照试验的基础，该试验将提供 证据表明CDCG干预措施在提高艾滋病毒处方阿片类药物安全性方面的有效性 初级保健机构，还将提供关于如何最好地在其他地方实施 CDCG 的见解 设置。

项目成果

Decreasing risk among HIV patients on opioid therapy for chronic pain: Development of the TOWER intervention for HIV care providers.

降低 HIV 患者接受阿片类药物治疗慢性疼痛的风险：为 HIV 护理人员开发 TOWER 干预措施。

• DOI: 10.1016/j.conctc.2019.100468
• 发表时间: 2019
• 期刊: Contemporary clinical trials communications
• 影响因子: 1.5
• 作者: Robinson-Papp,Jessica;Aberg,Judith;Benn,EmmaKT;Bryan,Angela;Cedillo,Gabriela;Chikamoto,Yosuke;George,MaryCatherine;Horn,Brady;Kamler,Alexandra;Navis,Allison;Nmashie,Alexandra;Scherer,Maya;Starkweather,Angela;Vickrey,Barbara

Toward Safer Opioid Prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial.

• DOI: 10.1186/s13722-022-00311-8
• 发表时间: 2022-05-16
• 期刊: ADDICTION SCIENCE & CLINICAL PRACTICE
• 影响因子: 3.7
• 作者: Cedillo, Gabriela;George, Mary Catherine;Deshpande, Richa;Benn, Emma K. T.;Navis, Allison;Nmashie, Alexandra;Siddiqui, Alina;Mueller, Bridget R.;Chikamoto, Yosuke;Weiss, Linda;Scherer, Maya;Kamler, Alexandra;Aberg, Judith A.;Vickrey, Barbara G.;Bryan, Angela;Horn, Brady;Starkweather, Angela;Fisher, Jeffrey;Robinson-Papp, Jessica
• 通讯作者: Robinson-Papp, Jessica

Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for Assessing Adherence to the Centers for Disease Control Opioid Prescribing Guidelines.

验证更安全的阿片类药物处方评估工具 (SOPET)，用于评估疾病控制中心阿片类药物处方指南的遵守情况。

• DOI: 10.1093/pm/pnaa138
• 发表时间: 2020
• 期刊: Pain medicine (Malden, Mass.)
• 作者: Navis,Allison;George,Mary-Catherine;Nmashie,Alexandra;Hoang,Ethan;Cedillo,Gabriela;Robinson-Papp,Jessica
• 通讯作者: Robinson-Papp,Jessica

Patient recommendations for opioid prescribing in the context of HIV care: findings from a set of public deliberations.

在艾滋病毒护理背景下患者对阿片类药物处方的建议：一系列公众审议的结果。

• DOI: 10.1080/09540121.2019.1705962
• 发表时间: 2020
• 期刊: AIDS care
• 影响因子: 1.7
• 作者: Scherer,Maya;Weiss,Linda;Kamler,Alexandra;George,Mary-Catherine;Navis,Allison;Gebhardt,Yves;Robinson-Papp,Jessica
• 通讯作者: Robinson-Papp,Jessica

Toward safer opioid prescribing: effects of the TOWER intervention on HIV care providers.

实现更安全的阿片类药物处方：TOWER 干预对艾滋病毒护理人员的影响。

• DOI: 10.1080/09540121.2021.1887444
• 发表时间: 2022
• 期刊: AIDS care
• 影响因子: 1.7
• 作者: Scherer,Maya;Kamler,Alexandra;Weiss,Linda;George,Mary-Catherine;Cedillo,Gabriela;Cárdenas,Luisa;Daniel,Sheaba;DeGarmo,Ellie;Leavell,Yaowaree;Lin,Tiffany;Robinson-Papp,Jessica
• 通讯作者: Robinson-Papp,Jessica