Safe Opioid Prescription Practice

安全阿片类药物处方实践

• 批准号: 8928487
• 负责人: Janette Baird
• 金额: $ 19.8万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8928487
• 关键词: Safe; Opioid; Prescription; Practice

DESCRIPTION (provided by applicant): Prescribing opioids to injured patients who are discharged from an inpatient trauma admission is almost ubiquitous; however up to 26% of patients prescribed opioids for chronic pain abuse them leaving them at an increased risk of overdose and overdose fatality. Addressing this problem through an institutional level approach involving both patients and providers, including changes in physician prescription behaviors and directly intervening with the patients to increase knowledge of risks of opioid misuse and overdose, affords us the best opportunity to address this escalating public health concern. Using a quasi-experimental design we will compare the effect of adopting and implementing a Safe Opioid Prescription Practice (SOPP) protocol within a Level 1 trauma service team compared to a Level 1 trauma service team implementing standard care. Providers at both sites will complete web-based surveys to assess baseline knowledge, attitudes and barriers related to safe prescription practices. The intervention site will complete technical assistance activities to lead to the adoption and implementation of a SOPP protocol. The control site will continue to offer standard care to trauma patients throughout all phases. To measure institutional level changes, chart reviews will be conducted at both sites using a blinded medical review of discharged trauma service patients at baseline, early implementation, implementation and maintenance phases. To measure patient level changes, we will assess patient perception of the discharge experience at both sites during the adoption phase (Cohort 1=100); implementation phase (Cohort 2=100) and maintenance phase (Cohort 3=100) via telephone interview within 7 days post discharge. Three month interviews will also be conducted with Cohort 2 to assess patient opioid usage, pain management strategies and Naloxone usage among Cohort 2. The aims of the proposed research study are to 1) examine and measure the adoption, implementation and maintenance of the SOPP protocol in the intervention site compared to standard care site and 2) to assess patient level outcomes of the SOPP protocol. The secondary aim of this study is to assess the effect the SOPP protocol on provider prescribing practices comparing the average dosage (in morphine milligram equivalents) and duration of dose from the chart review at baseline to the early implementation, implementation and maintenance phases of the study. The findings from this study will allow us to better understand the translation of a safe opioid prescription practice and has the potential to impact best practices for patient discharge within Level 1 trauma centers.

描述（由申请人提供）：为创伤住院出院的受伤患者开阿片类药物的情况几乎无处不在；然而，高达 26% 的患者因长期疼痛而服用阿片类药物，滥用药物导致他们服用过量和过量死亡的风险增加。通过涉及患者和提供者的机构层面方法解决这一问题，包括改变医生处方行为以及直接干预患者以增加对阿片类药物滥用和过量风险的了解，为我们提供了解决这一不断升级的公共卫生问题的最佳机会。使用准实验设计，我们将比较在 1 级创伤服务团队中采用和实施安全阿片类药物处方实践 (SOPP) 协议与实施标准护理的 1 级创伤服务团队的效果。两个站点的提供者将完成基于网络的调查，以评估与安全处方实践相关的基线知识、态度和障碍。干预现场将完成技术援助活动，以引导 SOPP 协议的采用和实施。控制中心将继续在所有阶段为创伤患者提供标准护理。为了衡量机构层面的变化，将在两个地点进行图表审查，在基线、早期实施、实施和维护阶段对出院创伤服务患者进行盲法医学审查。为了衡量患者水平的变化，我们将在采用阶段评估患者对两个地点出院经历的感知（队列 1 = 100）；实施阶段（队列 2 = 100）和维持阶段（队列 3 = 100）在出院后 7 天内通过电话访谈。还将对第 2 组进行为期三个月的访谈，以评估第 2 组患者的阿片类药物使用情况、疼痛管理策略和纳洛酮使用情况。拟议研究的目的是 1) 与标准护理场所相比，检查和衡量干预场所 SOPP 方案的采用、实施和维护情况，2) 评估 SOPP 方案的患者水平结果。本研究的次要目的是评估 SOPP 方案对提供者处方实践的影响，比较平均剂量（以吗啡毫克当量为单位）和从基线图表审查到研究的早期实施、实施和维持阶段的剂量持续时间。这项研究的结果将使我们能够更好地理解安全阿片类药物处方实践的转化，并有可能影响 1 级创伤中心患者出院的最佳实践。