Scherer Maya, Kamler Alexandra, Weiss Linda, George Mary-Catherine, Cedillo Gabriela, Cárdenas Luisa, Daniel Sheaba, DeGarmo Ellie, Leavell Yaowaree, Lin Tiffany, Robinson-Papp Jessica
Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA.
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
AIDS Care. 2022 Apr;34(4):440-445. doi: 10.1080/09540121.2021.1887444. Epub 2021 Mar 9.
Rates of opioid use disorder and associated deaths remain alarmingly high. Measures to address the epidemic have included reductions in opioid prescribing, in part guided by the Centers for Disease Control Opioid Prescribing Guideline (CDCG). While reductions in over-prescribing have occurred, these measures have also resulted in decreased access and adverse outcomes for some stable opioid-treated chronic pain patients. The TOWard SafER Opioid Prescribing (TOWER) intervention was designed to support HIV primary care providers in use of the CDCG and in decision-making and patient-provider communication regarding safe opioid prescribing. Eleven HIV primary care providers and 40 of their patients were randomized into intervention and control groups. Transcripts from 21 patient visits were analyzed, focusing on opioid and pain-related communications. Findings from this research indicate greater alignment with the CDCG among visits carried out with providers in the TOWER intervention group. However, control group visits were notably consistent with guideline recommendations in several key areas. Differences observed between the intervention and control group visits demonstrate intervention strengths, as well as areas where additional work needs to be done to ensure prescribing and communication consistent with the CDCG.
阿片类药物使用障碍率及相关死亡率仍高得惊人。应对这一流行病的措施包括减少阿片类药物处方，部分是在疾病控制中心阿片类药物处方指南（CDCG）的指导下进行的。虽然过度处方有所减少，但这些措施也导致一些稳定的接受阿片类药物治疗的慢性疼痛患者获得药物的机会减少以及出现不良后果。迈向更安全阿片类药物处方（TOWER）干预措施旨在支持艾滋病初级保健提供者使用CDCG，并在安全阿片类药物处方方面进行决策以及医患沟通。11名艾滋病初级保健提供者及其40名患者被随机分为干预组和对照组。对21次患者就诊的记录进行了分析，重点是与阿片类药物和疼痛相关的沟通。这项研究的结果表明，在TOWER干预组中，提供者进行的就诊与CDCG的一致性更高。然而，对照组的就诊在几个关键领域与指南建议显著一致。干预组和对照组就诊之间观察到的差异显示了干预措施的优势，以及需要开展更多工作以确保处方和沟通符合CDCG的领域。
