Prescribers, Pharmacists, & the Opioid Dilemma: a Multi-Site Qualitative Study

描述（由申请人提供）：该项目的总体目标是提高我们对初级保健提供者（医生、医师助理和执业护士）和药剂师的阿片类药物处方和配药决策过程的理解。自1980年以来，慢性阿片类药物治疗慢性非癌性疼痛（CNCP）的使用急剧增加。在CNCP的COT使用增加的同时，处方阿片类药物使用障碍（滥用和依赖）和阿片类药物过量死亡的比例也在增加。处方阿片类药物使用障碍是增长最快的药物滥用形式，在美国，处方阿片类药物是意外药物过量的最常见原因（根据疾病控制和预防中心的“流行病”）。处方阿片类药物用于CNCP的临床医生面临的主要困境是如何最好地平衡疼痛缓解的益处与阿片类药物滥用的风险。初级保健提供者和药剂师以缓解疼痛为目的开处方和分发阿片类药物，在这一流行病中发挥着核心作用，尽管这是无意的。迫切需要培训、政策和干预措施，以改善疼痛管理，减少阿片类药物滥用、转移和死亡。为了取得成功，这些项目需要建立在对初级保健提供者和药剂师在处方和分发阿片类药物时的决策过程的透彻理解的基础上。不幸的是，人们对这些决策过程知之甚少。为了填补这一知识空白，我们建议使用面对面，定性，半结构化访谈来调查初级保健提供者和药剂师关于CNCP COT的决策过程。定性方法是本研究的理想方法，因为先前的证据不足以构建关于如何改善阿片类药物临床决策的概念模型。我们组建了一个由医生、卫生服务研究人员、药剂师和具有慢性疼痛、成瘾和精神病学内容专长的定性方法专家组成的多学科团队，分析有关初级保健提供者和药剂师决策的详细定性数据。研究结果将用于构建初级保健提供者和药剂师对慢性轻型病COT处方和调剂行为的概念模型。这些模型将使不同的利益攸关方能够以知情的方式解决这一复杂问题，就通过培训、质量改进基础设施、临床决策支持以及公共和临床政策解决处方类阿片流行病的具体方法产生可检验的假设。

DESCRIPTION (provided by applicant): The overarching goal of this project is to enhance our understanding of the opioid prescribing and dispensing decision-making processes of primary care providers (physicians, physician assistants, and nurse practitioners) and pharmacists. Since 1980, use of chronic opioid therapy (COT) for chronic non-cancer pain (CNCP) has increased dramatically. Increases in use of COT for CNCP have been paralleled by increased rates of prescription opioid use disorders (abuse and dependence) and opioid overdose deaths. Prescription opioid use disorders are the fastest growing form of drug abuse, and prescription opioids are the most common cause of accidental drug overdose, in the United States (an "epidemic," per the Centers for Disease Control and Prevention). The central dilemma facing clinicians who prescribe opioids for CNCP is how to best balance the benefits of pain relief with the risks of opioid misuse. Primary care providers and pharmacists who prescribe and dispense opioids with the objective of relieving pain play a central, albeit unintentional, role in this epidemic. Training, policies, and interventions are urgently needed to improve pain management and decrease opioid abuse, diversion, and deaths. To succeed, these programs need to be predicated on a thorough understanding of primary care providers' and pharmacists' decision-making processes when they prescribe and dispense opioids. Unfortunately these decision-making processes are poorly understood. To fill this knowledge gap, we propose to use face-to-face, qualitative, semi structured interviews to investigate primary care provider and pharmacist decision-making processes regarding COT for CNCP. Qualitative methods are ideal for this study because prior evidence is insufficient to construct conceptual models about how to improve clinical decision making about opioids. We have assembled a multidisciplinary team of physicians, health services researchers, pharmacists, and qualitative methods experts with content expertise in chronic pain, addictions, and psychiatry to analyze detailed qualitative data about primary care provider and pharmacist decision making. Results will be used to construct conceptual models of primary care providers' and pharmacists' prescribing and dispensing behaviors regarding COT for CNCP. These models will enable diverse stakeholders to address this complex problem in an informed manner, generating testable hypotheses on specific approaches to addressing the prescription opioid epidemic via training, quality improvement infrastructure, clinical decision support, and public and clinical policy.