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

经济学应用

• 批准号: 10249262
• 负责人: JASON N. DOCTOR
• 金额: $ 60.28万
• 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 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10249262
• 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; 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; drug testing; eVisit; expectation; improved; insight; morphine equivalent; non-cancer pain; non-opioid analgesic; novel; opioid exposure; opioid misuse; opioid overdose; opioid policy; 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.

摘要 缺乏证据表明长期使用阿片类药物对非癌症疼痛和 危害​的大量证据。去年，疾病控制和预防中心 美国疾病控制与预防中心(CDC)发布《疾病控制与预防中心关于阿片类药物治疗慢性疼痛的指南》，鼓励安全 以及阿片类药物的有效替代品，当患者无法恢复时停止使用阿片类药物 正常的活动和谨慎的服药策略。然而，指导方针的遵从性差是一个普遍现象 令人担忧，并可能阻碍吸收。​我们之前的研究使用了来自行为的洞察 经济学和社会心理学，以提高指南的遵从性。我们建议将这些应用于 经济学和社会心理学用于改善阿片类药物的技术 处方安全(AESOPS)试验改善对疾病预防控制中心和俄勒冈州疼痛的依从性 指导疼痛管理指南。在R21阶段，我们将评估 实施以下候选提示：1)默认(符合以下条件的准则协调操作 发生在临床医生未采取行动时)，2)预先承诺(临床医生提前承诺 以指导遵守的行为，以约束他们未来的这些行为)，3)理由 (由临床医生输入的自由文本回复，解释未遵循指南的原因以及 它们被记录为电子健康记录中的患者笔记)；当 删除默认设置并且不履行承诺，4)同行比较(一种 社会激励的绩效报告)和5)推动提高突出度和 不良阿片类药物事件的可用性。在R33阶段，我们将进行AESOPS试验，并 18个月的整群随机试验。这项试验覆盖了美国的374家初级保健诊所。 比较三种情况：C1)同级比较和调整，C2)默认、预承诺 或可获得的不良事件添加到C1干预中，C3)教育对照。初级阶段 ​&GT；​患者的临床结果为每月吗啡当量(ME)50 mg 我的每日剂量。其次，结果是苯二氮卓类药物的联合处方和剂量率 升级到​&>​每天50毫克ME。我们预计AESOPS试验将提供新的知识 关于如何提高对疾病预防控制中心阿片类药物治疗慢性疼痛指南的依从性 以及一致的疼痛指南。这项试验也可能帮助我们理解如何防止未来 通过降低不必要人口减少阿片类药物使用障碍和阿片中毒死亡事件 接触到这些药物。