Evaluation of the Utah Clinical Guidelines on Prescribing Opioids.

描述(由申请人提供)： 项目摘要/摘要 拟议目标1.评估犹他州临床指南对阿片类药物预描述的影响。2.评估教授临床医生如何解释和使用指南的教育干预的影响。重要性处方药导致的意外死亡在犹他州和美国是一个日益严重的问题。在犹他州，与处方药物有关的年度过量死亡人数从2001年开始大幅增加，这一增长一直持续到2007年。自2003年以来，犹他州受伤死亡的主要原因是处方药中毒-与阿片类药物相关的中毒是主要犯罪者。1997-2007年期间，犹他州非非法药物中毒死亡人数增加了约290%，从每10万人年4人增加到每10万人年12人。这一增长主要是由于处方阿片类止痛药导致的死亡。从2001年到现在，犹他州因处方药过量而导致的急诊科就诊次数也在持续增加。4、5评估将允许提供有价值的信息，帮助其他州采用或适应类似的阿片类疼痛管理建议。目的通过本次评估，我们旨在确定指南对处方模式和安全监测的影响。我们还旨在评估医生将指南中的哪些工具纳入到他们的实践中。此外，我们计划评估教育干预对以下指南建议的影响。我们的假设是，接受如何使用指南的教育的医生将与疼痛治疗的最大改善有关。研究设计本研究建议比较犹他州卫生局最终确定并支持处方指南之前和之后整个州的疼痛管理做法。我们还计划进行一项临床随机设计，以评估强化教育干预的影响，旨在教提供者如何使用指南和工具来提高阿片类药物治疗的安全性。将使用多个数据库进行比较-州级数据库，包括犹他州受控物质数据库、犹他州所有付款人数据、生命记录和犹他州紧急情况部门遇到的数据。为了评估干预措施的影响，我们将衡量处方模式、安全监测、工具使用和不良药物事件的变化。医生还将被要求通过调查自我报告他们执业的变化。这些干预措施的设置评估将在犹他州卫生局(Udoh)使用犹他州卫生部保存和管理的数据库进行。教育干预在犹他州的诊所和医院进行。然后通过在线调查从参与调查的医生那里收集数据。参与者本研究建议在指南前后的比较中评估该州所有的阿片类药物处方者。大约300名提供者将参加强化教育干预和300名对照。我们还建议对88名犹他州社区诊所提供者进行图表审查，以确定教育干预如何影响他们对工具和文档的使用。结果指标1.医生处方模式的变化2.医生订购的EKG和睡眠检查的数量变化3.不良事件的数量减少(与阿片类药物相关的急诊科就诊和死亡)。4.医生使用的工具的变化(例如治疗计划、剂量指南) 公共卫生相关性： 项目简介：这个拟议的项目与公共健康相关，因为它有可能为使用和实施处方指南提供科学依据，以减少与处方止痛药相关的发病率和死亡率。

DESCRIPTION (provided by applicant): Project Summary/Abstract Proposed objectives 1. Evaluate the impact of the Utah Clinical Guidelines on Prescribing Opioids. 2. Evaluate the impact of an educational intervention that teaches clinicians how to interpret and use the guidelines. Importance Unintentional fatalities due to prescription medications are an increasing problem in Utah and the United States. In Utah, the annual number of prescription drug-related overdose deaths began to increase substantially in 2001 and the increase has continued through 2007. Since 2003 the leading cause of injury death in Utah has been poisoning from prescription drugs - with opioid-related poisonings as the primary offender. During the years 1997-2007 deaths attributed to non-illicit drug poisoning increased by approximately 290% in Utah from 4 per 100,000 person-years to 12 per 100,000 person-years. The increase was largely due to deaths from prescription opioid pain medications. The number of emergency department encounters stemming from prescription drug overdose has also continued to increase in Utah from 2001-present.4, 5 Evaluation will allow provide valuable information that will help other states adopt or adapt similar opioid pain management recommendations. Objectives Through this evaluation we aim to determine the impact the guidelines have on prescribing patterns and safety monitoring. We also aim to evaluate which tools from the guidelines the physician's are incorporating into their practice. In addition, we plan to evaluate the impact of the educational intervention on following guideline recommendations. Our hypothesis is that the physicians who receive education on how to use the guidelines will be associated with the biggest improvement in pain treatment. Study Design This study proposes to compare pain management practices for the entire state before and after the prescribing guidelines were finalized and supported by Utah Department of Health. We also plan a clinic- randomized design to evaluate the impact of an intensive educational intervention designed to teach providers how to use the guideline and tools for improving the safety of opioid treatment. Comparison will be done using multiple databases state-level databases that include the Utah Controlled Substance Database, the Utah All Payer Data, Vital Records, and Utah Emergency Department Encounter Data. To evaluate the impact of the interventions we will measure change in prescribing patterns, safety monitoring, use of tools, and adverse drug events. Physicians' will also be asked to self-report the change in their practice through a survey. Setting Evaluation of these interventions will be done at the Utah Department of Health (UDOH) using databases that are housed and managed at the UDOH. The educational intervention takes place in clinics and hospitals across the state of Utah. Data is then collected from participating physicians via an online survey. Participants This study proposes to evaluate all opioid prescribers in the state in the pre and post guideline comparison. Approximately 300 providers will be enrolled in the intensive educational intervention and 300 controls. We also propose to conduct chart-review on 88 Utah Community Clinic providers to determine how the educational intervention impacted their use of tools and documentation. Outcome Measures 1. Changes in prescribing patterns of physicians 2. Changes in the number of EKGs and Sleep Studies ordered by physicians 3. Reduction in number of adverse events (opioid-related emergency department visits and deaths). 4. Changes in the tools used by physicians (e.g. treatment plans, dosing guidelines) PUBLIC HEALTH RELEVANCE: Project Narrative: This proposed project is relevant to public health because of the potential it has to provide scientifically based evidence for the use and implementation of prescribing guidelines to reduce morbidity and mortality related to prescription pain medications.