Leece Pamela, Buchman Daniel Z, Hamilton Michael, Timmings Caitlyn, Shantharam Yalnee, Moore Julia, Furlan Andrea D
Public Health Ontario, Toronto, Ontario, Canada.
University Health Network, Toronto, Ontario, Canada.
BMJ Open. 2017 Apr 26;7(4):e013244. doi: 10.1136/bmjopen-2016-013244.
In North America, drug overdose deaths are reaching unprecedented levels, largely driven by increasing prescription opioid-related deaths. Despite the development of several opioid guidelines, prescribing behaviours still contribute to poor patient outcomes and societal harm. Factors at the provider and system level may hinder or facilitate the application of evidence-based guidelines; interventions designed to address such factors are needed.
Using implementation science and behaviour change theory, we have planned the development and evaluation of a comprehensive Opioid Self-Assessment Package, designed to increase adherence to the Canadian Opioid Guideline among family physicians. The intervention uses practical educational and self-assessment tools to provide prescribers with feedback on their current knowledge and practices, and resources to improve their practice. The evaluation approach uses a pretest and post-test design and includes both quantitative and qualitative methods at baseline and 6 months. We will recruit a purposive sample of approximately 10 family physicians in Ontario from diverse practice settings, who currently treat patients with long-term opioid therapy for chronic pain. Quantitative data will be analysed using basic descriptive statistics, and qualitative data will be analysed using the Framework Method.
The University Health Network Research Ethics Board approved this study. Dissemination plan includes publications, conference presentations and brief stakeholder reports. This evidence-informed, theory-driven intervention has implications for national application of opioid quality improvement tools in primary care settings. We are engaging experts and end users in advisory and stakeholder roles throughout our project to increase its national relevance, application and sustainability. The performance measures could be used as the basis for health system quality improvement indicators to monitor opioid prescribing. Additionally, the methods and approach used in this study could be adapted for other opioid guidelines, or applied to other areas of preventive healthcare and clinical guideline implementation processes.
在北美，药物过量致死率正达到前所未有的水平，这在很大程度上是由与处方阿片类药物相关的死亡人数增加所驱动的。尽管已经制定了多项阿片类药物指南，但处方行为仍然导致患者预后不良和社会危害。提供者和系统层面的因素可能会阻碍或促进循证指南的应用；因此需要设计旨在解决此类因素的干预措施。
运用实施科学和行为改变理论，我们计划开发并评估一个全面的阿片类药物自我评估包，旨在提高家庭医生对《加拿大阿片类药物指南》的依从性。该干预措施使用实用的教育和自我评估工具，为开处方者提供有关其当前知识和实践的反馈，以及改善其实践的资源。评估方法采用前测和后测设计，并在基线和6个月时包括定量和定性方法。我们将从安大略省不同执业环境中有意抽取约10名家庭医生作为样本，这些医生目前正在为慢性疼痛患者进行长期阿片类药物治疗。定量数据将使用基本描述性统计进行分析，定性数据将使用框架法进行分析。
大学健康网络研究伦理委员会批准了本研究。传播计划包括发表论文、在会议上展示以及向利益相关者提交简要报告。这种基于证据、理论驱动的干预措施对阿片类药物质量改进工具在初级保健环境中的全国性应用具有启示意义。在整个项目中，我们让专家和最终用户担任咨询和利益相关者角色，以提高其在全国范围内的相关性、应用和可持续性。这些绩效指标可作为卫生系统质量改进指标的基础，以监测阿片类药物的处方情况。此外，本研究中使用的方法和途径可适用于其他阿片类药物指南，或应用于预防性医疗保健和临床指南实施过程的其他领域。
