Promoting the implementation of clinical guidelines for opioid prescribing in primary care using systems consultation

利用系统咨询促进初级保健中阿片类药物处方临床指南的实施

• 批准号: 10198891
• 负责人: Andrew Quanbeck
• 金额: $ 71.71万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198891
• 关键词: Academic Detailing; Address; Adoption; Affect; Cessation of life; Clinic; Clinical; Clinical Trials; Communities; Consensus; Consultations; Control Groups; Dose; Effectiveness; Evidence based practice; Goals; Grant; Guidelines; Health Personnel; Health Status; Health system; Healthcare; Individual; Intervention; Knowledge; Learning; Literature; Measures; Medical; Morphine; Names; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Patients; Pharmaceutical Preparations; Physicians; Pilot Projects; Primary Health Care; Process; Provider; Randomized; Recommendation; Research; Research Design; Research Personnel; Sequential Multiple Assignment Randomized Trial; System; Testing; Time; Training; Wisconsin; Work; base; clinical implementation; comparative effectiveness; contextual factors; cost; cost effectiveness; cost estimate; flexibility; follow-up; group intervention; implementation science; implementation strategy; improved; incremental cost-effectiveness; innovation; milligram; opioid epidemic; opioid mortality; opioid policy; opioid therapy; overdose death; overdose risk; peer coaching; prescription opioid; primary care setting; primary outcome; systematic review; tool; uptake; virtual

Project Summary/Abstract The prescription opioids crisis begs for a flexible but generalizable systems-level implementation strategy to widely improve prescribing practices. A consensus has emerged about safer prescribing practices, but determining how to implement needed changes remains a challenge. The proposed research will test an innovative way to implement that consensus, adaptive systems consultation. The research aims to identify which sequence and combination of implementation strategies works most effectively in promoting practice change in different primary care clinics. The research serves the long-term goal of learning how to optimize implementation strategies to promote evidence-based practice in primary care settings. This proposal builds on a pilot study that tested systems consultation in 4 primary care clinics, which found that systems consultation was feasible, acceptable, and effective in reducing patients’ average opioid dose (an outcome directly related to the risk of overdose death). The proposed research tests an adaptive version of the strategy tailored to different levels (health system, clinic, prescriber). The intervention starts with academic detailing, a systems- level strategy consisting of an expert-led training session plus distance-based follow-up. This strategy continues for 18 months and serves as the control condition. At 3 months, half of the clinics will be randomized to receive practice facilitation, a clinic-level strategy aimed at improving processes related to opioid prescribing. At 6 months, prescribers will be assessed for guideline concordance, and half of non-guideline concordant prescribers will be randomized to receive physician peer coaching, a prescriber-level strategy, in which a physician expert gives one-on-one advice to prescribers in managing their patients on long-term opioid therapy. These 3 strategies will be delivered in a sequential, multiple-assignment randomized trial to 38 clinics from 3 Wisconsin health systems. The study compares the effect on average morphine milligram dose of an adaptive systems consultation implementation strategy (the intervention group) vs. academic detailing alone (the control group). The study will answer questions about the comparative effectiveness of prominent implementation strategies (academic detailing, practice facilitation, and physician peer coaching) in a single, highly efficient study. The study also develops an assessment of the contextual factors that influence the effectiveness of different implementation strategies and estimates the costs of delivering 4 different sequences and combinations of implementation strategies. This study will advance implementation science by testing a multi-level implementation strategy that can be tailored to assess contextual factors influencing implementation. This fundamental knowledge could be used to help mitigate the opioid crisis and in optimizing the selection and deployment of implementation strategies used to promote the uptake of many proven but underused practices throughout healthcare.

项目总结/摘要 处方阿片类药物危机需要一个灵活但可推广的系统级实施战略， 广泛改进处方做法。关于更安全的处方做法已达成共识，但 确定如何实施必要的变革仍然是一项挑战。拟议的研究将测试一个 创新方式落实协商一致，适应制度协商。该研究旨在确定 实施战略的哪种顺序和组合在促进实践方面最有效 不同的初级保健诊所。这项研究服务于学习如何优化的长期目标 实施战略，以促进在初级保健环境中循证实践。该提案基于 一项在4个初级保健诊所测试系统咨询的试点研究发现， 是可行的，可接受的，有效地减少患者的平均阿片类药物剂量（结果直接相关 过量死亡的风险）。拟议的研究测试了一个适应性版本的战略， 不同层面（卫生系统、诊所、开处方者）。干预从学术细节开始，一个系统- 该战略包括一个专家主导的培训班和远程后续行动。这一战略 持续18个月，并作为对照条件。在3个月时，一半的诊所将被随机化 获得实践便利，这是一项旨在改进与阿片类药物处方有关的流程的诊所级战略。 在6个月时，将评估处方者的指南一致性，一半的非指南一致性 处方者将随机接受医生同行指导，这是一种处方者级别的策略， 医生专家为处方者提供一对一的建议，以管理长期服用阿片类药物的患者 疗法这3种策略将在38家诊所进行一项连续、多分配的随机试验 来自威斯康星州的三个医疗系统这项研究比较了平均吗啡毫克剂量的效果， 适应性系统咨询实施策略（干预组）vs.单独的学术细节 (the对照组）。这项研究将回答有关突出的比较有效性的问题， 实施策略（学术细节，实践促进，和医生同行指导）在一个单一的， 高效的学习。该研究还评估了影响学生学习的背景因素， 不同实施战略的有效性，并估计提供4种不同序列的成本 以及实施战略的组合。这项研究将通过测试一个 多层次的实施战略，可定制以评估影响 实施.这些基本知识可以用来帮助缓解阿片类药物危机， 选择和部署实施战略，以促进采用许多经过验证但 在整个医疗保健中使用不足的做法。