Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA.
Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.
Implement Sci. 2018 Nov 29;13(1):145. doi: 10.1186/s13012-018-0838-2.
Dissemination of evidence-based practices that can reduce morbidity and mortality is important to combat the growing opioid overdose crisis in the USA. Research and expert consensus support reducing high-dose opioid therapy, avoiding risky opioid-benzodiazepine combination therapy, and promoting multi-modal, collaborative models of pain care. Collaborative care interventions that support primary care providers have been effective in medication tapering. We developed a patient-centered Primary Care-Integrated Pain Support (PIPS) collaborative care clinical program based on effective components of previous collaborative care interventions. Implementation facilitation, a multi-faceted and dynamic strategy involving the provision of interactive problem-solving and support during implementation of a new program, is used to support key organizational staff throughout PIPS implementation. The primary aim of this study is to evaluate the effectiveness of the implementation facilitation strategy for implementing and sustaining PIPS in the Veterans Health Administration (VHA). The secondary aim is to examine the effect of the program on key patient-level clinical outcomes-transitioning to safer regimens and enhancing access to complementary and integrative health treatments. The tertiary aim is to determine the categorical costs and ultimate budget impact of PIPS implementation.
This multi-site study employs an interrupted time series, hybrid type III design to evaluate the effectiveness of implementation facilitation for a collaborative care clinical program-PIPS-in primary care clinics in three geographically diverse VHA health care systems (sites). Participants include pharmacists and allied staff involved in the delivery of clinical pain management services as well as patients. Eligible patients are prescribed either an outpatient opioid prescription greater than or equal to 90 mg morphine equivalent daily dose or a combination opioid-benzodiazepine regimen. They must also have an upcoming appointment in primary care. The Consolidated Framework for Implementation Research will guide the mixed methods work across the formative evaluation phases and informs the selection of activities included in implementation facilitation. The RE-AIM framework will be used to assess Reach, Effectiveness, Adoption, Implementation, and Maintenance of PIPS.
This implementation study will provide important insight into the effectiveness of implementation facilitation to enhance uptake of a collaborative care program in primary care, which targets unsafe opioid prescribing practices.
传播能够降低发病率和死亡率的循证实践对于应对美国日益严重的阿片类药物过量危机至关重要。研究和专家共识支持减少高剂量阿片类药物治疗，避免危险的阿片类药物-苯二氮䓬类药物联合治疗，并促进多模式、协作的疼痛护理模式。支持初级保健提供者的协作护理干预措施在药物逐渐减少方面是有效的。我们根据以前的协作护理干预措施的有效组成部分，开发了一个以患者为中心的初级保健综合疼痛支持（PIPS）协作护理临床项目。实施促进是一种多方面的、动态的策略，涉及在实施新计划时提供交互式问题解决和支持，用于在整个 PIPS 实施过程中为关键组织人员提供支持。这项研究的主要目的是评估实施促进策略在退伍军人健康管理局（VHA）中实施和维持 PIPS 的有效性。次要目的是检查该计划对关键患者水平临床结果的影响-过渡到更安全的方案，并增强获得补充和综合健康治疗的机会。 tertiary 目的是确定 PIPS 实施的分类成本和最终预算影响。
这项多站点研究采用中断时间序列、混合 III 型设计来评估实施促进策略对协作护理临床项目-PIPS-在三个地理位置不同的 VHA 医疗保健系统（站点）中的初级保健诊所的有效性。参与者包括参与提供临床疼痛管理服务的药剂师和相关工作人员以及患者。合格患者的门诊阿片类药物处方大于或等于 90mg 吗啡当量每日剂量，或阿片类药物-苯二氮䓬类药物联合治疗方案。他们还必须在初级保健中有一个即将到来的预约。实施研究的综合框架将指导形成性评估阶段的混合方法工作，并为实施促进中包含的活动选择提供信息。RE-AIM 框架将用于评估 PIPS 的范围、有效性、采用、实施和维持。
这项实施研究将为实施促进有效性提供重要见解，以增强初级保健中协作护理计划的采用，该计划针对不安全的阿片类药物处方实践。
