Primary care intervention to reduce prescription opioid overdoses

初级保健干预减少处方阿片类药物过量

• 批准号: 10027245
• 负责人: Amy S B Bohnert
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10027245
• 关键词: Address; Adverse event; Afghanistan; Alcohol consumption; Alcohol or Other Drugs use; Attention; Behavior; Behavior Therapy; Behavioral; Caring; Cessation of life; Clinic; Cognitive; Complement; Conflict (Psychology); Controlled Study; Data; Dose; Elements; Emergency department visit; Ensure; Future; General Population; Health Personnel; Healthcare Systems; Injury; Intervention; Iraq; Knowledge; Location; Measures; Mediator of activation protein; Mental Health; Modality; Motivation; Opioid; Opioid Analgesics; Outcome; Overdose; Pain; Pain management; Pain quality; Participant; Patient Care; Patient Self-Report; Patients; Personal Satisfaction; Pharmaceutical Preparations; Pharmacy facility; Prescription opioid overdose; Preventive Intervention; Primary Health Care; Provider; Public Health; Randomized; Randomized Controlled Trials; Records; Reporting; Risk; Risk Behaviors; Risk Reduction; Safety; Sedation procedure; Self Efficacy; Services; United States; Veterans; Violence; adverse outcome; behavior change; behavioral health; brief intervention; care providers; chronic pain; coping; evidence base; follow-up; health administration; improved; intervention effect; morphine equivalent; opioid mortality; opioid overdose; opioid therapy; opioid use; overdose prevention; overdose risk; pill; pragmatic trial; prescription opioid; prevent; recruit; therapy design; treatment as usual

 DESCRIPTION (provided by applicant): Reducing opioid pain medication-related adverse outcomes among patients prescribed opioids for pain is critical for ensuring safe and high quality pain care in the Veterans Health Administration (VHA). Overdose is one such adverse outcome; overdose has substantially increased over the past decade and is a highly significant concern for Veterans, VHA care providers, and other stakeholders. A number of VHA initiatives have sought to improve prescribing practices in an effort to address this problem. Concurrent strategies that reduce patient behaviors that increase overdose risk have the potential to complement these efforts, but have not been examined in a controlled study. Primary care is an ideal location for identifying patients prescribed opioids who are at risk for adverse outcomes. Recent initiatives, such as Primary Care Mental Health (PC-MH), have led to the integration of behavioral health providers into primary care and provide the opportunity to deliver behavioral interventions designed specifically to reduce risky opioid use. The purpose of the Prescription Opioid Safety Trial (POST) study is to conduct a randomized controlled trial of a brief intervention to reduce opioid overdose risk behaviors among VHA primary care patients receiving long-term opioid therapy. The intervention blends elements of motivational enhancement interventions for risky substance use and cognitive behavioral pain management interventions. This new intervention will be compared to an equal attention enhanced usual care condition, with both conditions delivered by PC-MH therapists. The study will recruit 450 patients with long-term opioid use who are currently prescribed opioid doses of 50 morphine-equivalent mg/day or greater (an indicator of elevated overdose risk) from primary care clinics at the VA Ann Arbor Healthcare System. The specific aims are: Aim 1) to examine if patients randomly assigned to a brief overdose prevention intervention report reduce

 描述（由申请人提供）： 减少服用阿片类药物治疗疼痛的患者中与阿片类止痛药相关的不良后果对于确保退伍军人健康管理局 (VHA) 安全和高质量的疼痛护理至关重要。服药过量就是这样一种不良后果。过去十年中，药物过量的情况大幅增加，这是退伍军人、VHA 护理提供者和其他利益相关者高度关注的问题。许多 VHA 倡议都试图改进处方实践，以解决这一问题。减少患者增加用药过量风险的行为的同时策略有可能补充这些努力，但尚未在对照研究中进行检验。初级保健是识别有不良后果风险的阿片类药物患者的理想场所。最近的举措，例如初级保健心理健康 (PC-MH)，已将行为健康提供者纳入初级保健，并提供了提供专门为减少阿片类药物使用风险而设计的行为干预措施的机会。 处方阿片类药物安全试验 (POST) 研究的目的是进行一项随机对照试验，进行简短干预，以减少接受长期阿片类药物治疗的 VHA 初级保健患者的阿片类药物过量风险行为。该干预措施融合了针对危险物质使用的动机增强干预措施和认知行为疼痛管理干预措施的要素。这种新的干预措施将与同等关注增强的常规护理条件进行比较，这两种条件均由 PC-MH 治疗师提供。该研究将招募 450 名长期使用阿片类药物的患者，这些患者目前从 VA Ann Arbor 医疗系统的初级保健诊所开出 50 吗啡当量毫克/天或更高剂量的阿片类药物（过量风险升高的指标）。具体目标是： 目标 1) 检查随机分配到简短过量预防干预报告的患者是否减少