Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial

经济学应用

• 批准号: 9419638
• 负责人: JASON N. DOCTOR
• 金额: $ 26.31万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9419638
• 关键词: Accident and Emergency department; Adherence; Adult; Adverse event; Affect; American; Behavior; Behavioral; Benzodiazepines; Binding; CCL4 gene; California; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinic; Clinical; Cluster randomized trial; Country; Data; Dose; Dose-Rate; Economics; Education; Electronic Health Record; Event; Exposure to; Future; Goals; Guideline Adherence; Guidelines; Health system; Illinois; Intervention; Knowledge; Life; Morphine; Motivation; Opioid; Oregon; Overdose; Pain; Pain management; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacotherapy; Phase; Poisoning; Population; Prevention Guidelines; Primary Health Care; Psyche structure; Psychology; Recommendation; Reporting; Safety; Social Psychology; Suggestion; Techniques; Testing; Text; Therapeutic; Treatment outcome; Urine; Visit; Work; base; behavioral economics; chronic pain; design; disorder prevention; drug testing; expectation; improved; insight; non-opioid analgesic; novel; opioid misuse; opioid use; opioid use disorder; peer; prescription opioid; prevent; primary outcome; response; secondary outcome; social; tool; trial comparing; uptake

ABSTRACT There is a lack of evidence that long-term opioid use offers benefit for noncancer pain and an abundance of evidence of harm​. Last year, the Centers for Disease Control and Prevention (CDC) issued the “CDC Guideline for Prescribing Opioids for Chronic Pain” to encourage safe and effective alternatives to opioids, discontinuation of opioids when patients do not resume normal activities and prudent dosing strategies. However, poor guideline adherence is a general concern and may impede uptake. ​Our prior studies have used insights from behavioral economics and social psychology to increase guideline adherence. We propose to apply these techniques within the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial to improve adherence to the CDC and to the Oregon Pain Guidance pain management guideline. In the R21 phase, we will assess the feasibility of implementing the following candidate nudges: 1) Defaults (guideline concordant actions that take place when clinicians fail to act), 2) precommitments (advanced commitments by clinicians to guideline adherent behaviors that bind them to these behaviors in the future), 3) justifications (free-text responses entered by the clinician that explain why guidelines were not followed and which are recorded as a patient note in the electronic health record); these are triggered when defaults are removed and commitments are not honored, 4) peer comparisons (a type of socially motivated performance reporting) and 5) a nudge to increase the salience and availability of adverse opioid events. In the R33 phase, we will conduct the AESOPS trial, an 18-month cluster randomized trial. The trial is across 374 primary care clinics in the U.S. We compare three conditions: C1) Peer comparison and justification , C2) defaults, precommitments or available adverse events added to the C1 interventions, C3) education control. The primary outcomes is clinician aggregate monthly mg morphine equivalent (ME) for patients with ​>​50 mg ME daily dose. Secondary, outcomes are benzodiazepine co-prescribing and rate of dose escalation to ​>​50 mg ME/day. We anticipate that the AESOPS trial will provide new knowledge about how to improve adherence to the CDC Guideline for Prescribing Opioids for Chronic Pain and to concordant pain guidelines. The trial may also help us understand how to prevent future incidents of opioid use disorder and opioid poisoning death by lowering unnecessary population exposure to these drugs.

抽象的 缺乏证据表明长期使用阿片类药物对非癌性疼痛有好处，并且 大量伤害证据​。去年，美国疾病控制与预防中心 (CDC) 发布了《CDC 处方阿片类药物治疗慢性疼痛指南》，鼓励安全使用阿片类药物 以及阿片类药物的有效替代品，当患者未恢复时停用阿片类药物 正常活动和谨慎的剂量策略。然而，普遍存在的问题是，对指南的遵守程度较差 关注并可能阻碍吸收。​我们之前的研究使用了行为学的见解 经济学和社会心理学，以提高指南的遵守率。我们建议应用这些 应用经济学和社会心理学中的技术来改善阿片类药物 处方安全 (AESOPS) 试验旨在提高 CDC 和俄勒冈疼痛计划的依从性 指导疼痛管理指南。在R21阶段，我们将评估可行性 实施以下候选推动： 1) 默认（指导一致的行动， 当临床医生未能采取行动时发生），2）预先承诺（临床医生的预先承诺 指导遵守的行为，使他们在未来遵守这些行为），3）理由 （临床医生输入的自由文本回复解释了为何未遵循指南以及 作为患者笔记记录在电子健康记录中）；这些被触发时 默认值被删除并且承诺不被兑现，4）同行比较（一种 出于社会动机的绩效报告）以及 5）推动提高显着性和 阿片类药物不良事件的可用性。在R33阶段，我们将进行AESOPS试验， 为期 18 个月的整群随机试验。该试验在美国 374 家初级保健诊所进行。 比较三个条件：C1) 同行比较和论证，C2) 默认、预先承诺 或将可用的不良事件添加到 C1 干预措施、C3) 教育控制中。初级 结果是临床医生每月总计毫克吗啡当量 (ME) 对于 ​>​50 mg 的患者 ME 每日剂量。其次，结果是苯二氮卓类药物的联合处方和剂量率 升级至​>​50 mg ME/天。我们预计 AESOPS 试验将提供新知识 关于如何提高对 CDC 慢性疼痛阿片类药物处方指南的遵守率 以及一致的疼痛指南。该试验还可以帮助我们了解如何预防未来 通过减少不必要的人口，减少阿片类药物使用障碍和阿片类药物中毒死亡事件 接触这些药物。