Intervention to Promote Opioid Treatment Agreements in Primary Care

项目摘要 为了帮助阻止阿片类镇痛药滥用，成瘾和过量的流行，专业疼痛协会 监管机构建议医生实施阿片类药物治疗协议（OTA）， 为长期服用阿片类镇痛药治疗慢性疼痛的患者制定治疗和监测计划。虽然 初级保健医生很少实施OTA，很少有人知道他们的障碍和促进者， OTA的实施，或关于干预措施，以改善OTA在初级保健环境中的实施。 这个指导患者为导向的研究职业发展奖应用的具体目标是： (1)确定在初级保健医生中实施OTA的障碍和促进因素，（2）制定 一个理论指导的干预，以促进OTA在初级保健的实施，（3）以确定是否 理论指导的干预与初级保健中OTA实施的变化相关。实现 这些目标，我们将进行半结构化的采访与初级保健医生使用的理论， 理性行动/计划行为理论作为理论框架，以及示例OTA文档作为 提示。根据我们的研究结果，我们将制定一个理论指导的干预措施，以促进OTA的实施， 然后通过预先测试和初级保健医生的反复反馈来完善它。我们预计 干预措施将包括量身定制的OTA文件以及支持OTA实施的组件， 包括两部分医生培训、参考指南和季度病例会议。最后我们将 在两个大型城市初级保健实践中进行为期12个月的干预试点研究。我们会进行 使用电子病历数据进行前后分析，以确定干预是否与 OTA文件或尿液药物检测使用的变化，这是所定义的监测策略的关键要素 的OTA。从本提案中获得的知识将为未来的研究和质量改进提供信息 在初级保健中促进负责任的阿片类药物处方的举措。 候选人乔安娜·L. Starrels，MD，MS，是阿尔伯特爱因斯坦的医学助理教授 医学院。她的长期目标是成为一名独立的调查员， 循证和负责任的阿片类药物处方策略为初级保健患者慢性疼痛。她 短期目标是获得以下方面的专业知识：阿片类药物滥用在疼痛管理，先进的定性研究， 改变医生行为的干预措施和纵向数据分析。斯塔瑞尔斯博士召集了一个 指导团队，包括药物滥用，疼痛管理和医疗保健提供方面的国家领导人。

PROJECT SUMMARY To help stem the epidemic of opioid analgesic misuse, addiction, and overdose, professional pain societies and regulatory agencies recommend that physicians implement opioid treatment agreements (OTAs) to define treatment and monitoring plans for patients prescribed long-term opioid analgesics for chronic pain. Though primary care physicians infrequently implement OTAs, little is known about their barriers to and facilitators of OTA implementation, or about interventions to improve OTA implementation in primary care settings. The specific aims of this Mentored Patient-Oriented Research Career Development Award application are: (1) to identify barriers to and facilitators of OTA implementation among primary care physicians, (2) to develop a theory-guided intervention to promote OTA implementation in primary care, and (3) to determine whether a theory-guided intervention is associated with changes in OTA implementation in primary care. To achieve these aims, we will conduct semi-structured interviews with primary care physicians using the Theory of Reasoned Action / Theory of Planned Behavior as a theoretical framework, and an example OTA document as a prompt. Based on our findings, we will develop a theory-guided intervention to promote OTA implementation, and then refine it through pretesting and iterative feedback from primary care physicians. We expect that the intervention will include a tailored OTA document as well as components that support OTA implementation, including a two-part physician training, a reference guide, and quarterly case conferences. Finally, we will conduct a 12-month pilot study of the intervention in two large urban primary care practices. We will conduct pre-post analyses using electronic medical record data to determine whether the intervention is associated with changes in the use of OTA documents or urine drug testing, a key element of the monitoring strategy defined by OTAs. The knowledge gained from this proposal will inform future research and quality improvement initiatives to promote responsible opioid prescribing in primary care. The candidate, Joanna L. Starrels, MD, MS, is an Assistant Professor of Medicine at Albert Einstein College of Medicine. Her long-term goal is to become an independent investigator in defining and promoting evidence-based and responsible opioid prescribing strategies for primary care patients with chronic pain. Her short-term goals are to gain expertise in: opioid misuse in pain management, advanced qualitative research, interventions to change physician behavior, and analysis of longitudinal data. Dr. Starrels has assembled a mentoring team that includes national leaders in substance abuse, pain management, and health care delivery.