From the University of Washington, Seattle, WA (KAS, BI, LMB); Clearwater Valley and St. Mary's Hospital and Clinics, Cottonwood, ID (CP); Kaiser Permanente Washington Health Research Institute, Seattle, WA (MP).
J Am Board Fam Med. 2021 Jan-Feb;34(1):89-98. doi: 10.3122/jabfm.2021.01.190100.
Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. We identify sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines.
We examined qualitative data (field notes and postintervention interview and focus group transcripts) from 6 rural and rural-serving primary care organizations with 20 clinic locations enrolled in a study evaluating a practice redesign program to improve opioid medication management for CNCP patients. Two independent researchers used content analysis to categorize data into key themes to develop an understanding of sociotechnical factors critical to creating and implementing an approach to tracking and monitoring of patients on long-term opioid therapy in primary care practices.
Four factors were critical to developing a tracking and monitoring system. For each we describe common challenges and approaches used by the clinics to overcome then. The first factor, buy-in and participation, was essential for accomplishing the other 3. The other factors occurred sequentially: 1) cohort identification-finding the right patients, 2) data collection and extraction-tracking the right data, and 3) data use-monitoring patients and adjusting care processes.
We identified common challenges and approaches to tracking and monitoring patients using long-term opioid therapy for CNCP in primary care. Based on these findings we provide recommendations to build capacity for tracking and monitoring for organizations that are engaged in improving safe opioid-prescribing practices for CNCP in primary care.
初级保健在为慢性非癌性疼痛（CNCP）患者安全开具阿片类药物方面面临挑战，特别是要解决药物过量、阿片类药物使用障碍和死亡的风险。我们确定了初级保健中有效跟踪和监测长期阿片类药物治疗患者的社会技术挑战、方法和建议，这是支持采用阿片类药物处方指南的关键组成部分。
我们检查了来自 6 个农村和农村服务的初级保健组织的定性数据（现场记录以及干预后的访谈和焦点小组记录），这些组织有 20 个诊所参与了一项评估实践重新设计方案的研究，该方案旨在改善 CNCP 患者的阿片类药物管理。两名独立研究人员使用内容分析将数据分类为关键主题，以了解对创建和实施初级保健实践中跟踪和监测长期阿片类药物治疗患者的方法至关重要的社会技术因素。
有四个因素对于开发跟踪和监测系统至关重要。对于每一个因素，我们都描述了诊所为克服这些因素而采用的常见挑战和方法。第一个因素是“认同和参与”，这对于完成其他三个因素是必不可少的。其他因素依次出现：1）队列识别-找到合适的患者，2）数据收集和提取-跟踪正确的数据，以及 3）数据使用-监测患者并调整护理流程。
我们确定了在初级保健中跟踪和监测长期使用阿片类药物治疗 CNCP 患者的常见挑战和方法。基于这些发现，我们为正在努力改善初级保健中 CNCP 安全阿片类药物处方实践的组织提供了跟踪和监测的建议。
