Parchman Michael L, Von Korff Michael, Baldwin Laura-Mae, Stephens Mark, Ike Brooke, Cromp DeAnn, Hsu Clarissa, Wagner Ed H
From the MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA (MLP, MVK, DC, CH, EHW); Department of Family Medicine, University of Washington, Seattle (L-MB, BI); Change Management Consulting, Seattle (MS).
J Am Board Fam Med. 2017 Jan 2;30(1):44-51. doi: 10.3122/jabfm.2017.01.160183.
The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain.
Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations. Site visits included interviews with leadership, clinic tours, observations of clinic processes and team meetings, and interviews with staff and clinicians. Data were reviewed to identify common attributes of clinic system changes around chronic opioid therapy (COT) management. These concepts were reviewed to develop narrative descriptions of key components of changes made to improve COT use.
Twenty of the thirty sites had addressed improvements in COT prescribing. Across these sites a common set of 6 Building Blocks were identified: 1) providing leadership support; 2) revising and aligning clinic policies, patient agreements (contracts) and workflows; 3) implementing a registry tracking system; 4) conducting planned, patient-centered visits; 5) identifying resources for complex patients; and 6) measuring progress toward achieving clinic objectives. Common components of clinic policies, patient agreements and data tracked in registries to assess progress are described.
In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing COT patients in primary care settings.
在美国，应对处方阿片类药物过度使用的挑战在基层医疗诊所环境中显得尤为突出。在此，我们描述了一个由6个构建模块组成的框架，以指导在此环境下解决阿片类药物用于慢性疼痛治疗的相关工作。
研究人员对美国30家基层医疗诊所进行了实地考察，这些诊所因采用基于团队的劳动力创新模式而被选中。实地考察包括与领导层的访谈、诊所参观、诊所流程和团队会议的观察，以及与工作人员和临床医生的访谈。对数据进行审查，以确定围绕慢性阿片类药物治疗（COT）管理的诊所系统变化的共同属性。对这些概念进行审查，以形成对为改善COT使用而做出的变化的关键组成部分的叙述性描述。
30个地点中的20个已经在COT处方方面进行了改进。在这些地点，确定了一组共同的6个构建模块：1）提供领导支持；2）修订并调整诊所政策、患者协议（合同）和工作流程；3）实施登记跟踪系统；4）进行有计划的、以患者为中心的就诊；5）为复杂患者确定资源；6）衡量实现诊所目标的进展情况。描述了诊所政策、患者协议的共同组成部分以及登记册中为评估进展而跟踪的数据。
为应对处方阿片类药物过度使用以及由此导致的过量用药和成瘾流行，基层医疗诊所正在通过一套共同的最佳实践来推动改进，这些实践解决了在基层医疗环境中管理COT患者的复杂挑战。
