Carpenter Rob E, Silberman Dave, Takemoto Jody K
The University of Texas at Tyler, Tyler, TX, USA.
Boston University, Boston, MA, USA.
Health Serv Insights. 2021 Dec 2;14:11786329211058283. doi: 10.1177/11786329211058283. eCollection 2021.
The opioid epidemic continues to be an ongoing public health crisis. Many primary health care providers aptly serve as the gatekeeper to opioid prescriptions. The opioid epidemic has challenged the primary care profession whilst many of these providers have opted out of opioid prescribing altogether. This unintended consequence affirms erosion to primary care that is vital to the ecosystem of opioid management. The purpose of this study was to understand strategies to deliver opioids safely and effectively. Results indicate primary care providers are uniquely positioned to make a positive opioid impact through focused change initiatives. Five common themes arose from the inductive analysis: (1) provide leadership support; (2) define standard of work; (3) conduct pre-visit reviews; (4) conduct post-visit reviews; and (5) measure progress. Then, each common theme was deductively analyzed through a view of Kotter's change theory to support an effective proxy for implementing and sustaining chronic opioid therapy in a primary care context. These finding have potential to provide actionable implications for health care management professionals and primary care organizations such as hospitals and group practices.
阿片类药物泛滥仍然是一场持续的公共卫生危机。许多初级卫生保健提供者恰当地充当了阿片类药物处方的把关人。阿片类药物泛滥给初级保健行业带来了挑战，与此同时，许多这类提供者已完全不再开具阿片类药物处方。这一意外后果证实了对初级保健的侵蚀，而初级保健对阿片类药物管理生态系统至关重要。本研究的目的是了解安全有效地提供阿片类药物的策略。结果表明，初级保健提供者具有独特的地位，可通过有针对性的变革举措对阿片类药物产生积极影响。归纳分析产生了五个共同主题：（1）提供领导支持；（2）定义工作标准；（3）进行就诊前评估；（4）进行就诊后评估；（5）衡量进展。然后，通过科特变革理论的视角对每个共同主题进行演绎分析，以支持在初级保健环境中实施和维持慢性阿片类药物治疗的有效代表。这些发现有可能为医疗保健管理专业人员以及医院和团体诊所等初级保健组织提供可采取行动的启示。
