Morgan Anna R, Hendricks Michelle A, El Ibrahimi Sanae, Hallvik Sara E, Hatch Brigit, Dickinson Caitlin, Wright Dagan, Fischer Michael A
National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA.
Comagine Health, Portland, OR, USA.
Drugs Context. 2021 Dec 15;10. doi: 10.7573/dic.2021-7-5. eCollection 2021.
The United States faces an opioid crisis with an unprecedented and increasing death rate from opioid overdose. Successfully reducing the rates of opioid use disorder (OUD) and overdose will require the engagement of frontline clinicians to prescribe opioids more safely and to build their capacity to treat patients with OUD using evidence-based approaches. The COVID-19 pandemic has created significant challenges for patients, clinicians and health systems and has been associated with increasing risks of overdoses and deaths. Herein, we review a multidisciplinary project designed to implement and evaluate clinic-based interventions in Oregon, USA, to improve pain management, opioid prescribing and treatment of OUD. The intervention, called Improving PaIn aNd OPiOId MaNagemenT in Primary Care (PINPOINT), combines practice facilitation, academic detailing and education through the Oregon ECHO Network. Implementation of PINPOINT has occurred across the Oregon Rural Practice-based Research Network and has involved 49 clinic sites to date. To evaluate the impact of the intervention, the research team created the Provider Results of Opioid Management and Prescribing Training (PROMPT), a dataset that links information from the state prescription drug monitoring program, all-payer claims database, emergency medical services, vital records and substance use disorder treatment system. The PROMPT dataset will allow evaluation of the impact of the intervention at both the clinician and clinic levels. Due to the constraints of the COVID-19 pandemic, elements of both implementation and evaluation required significant adaptations to continue to meet the original project goals.
美国面临阿片类药物危机，因阿片类药物过量导致的死亡率空前且不断上升。要成功降低阿片类药物使用障碍（OUD）和过量使用的发生率，需要一线临床医生参与进来，更安全地开具阿片类药物，并增强他们使用循证方法治疗OUD患者的能力。新冠疫情给患者、临床医生和卫生系统带来了巨大挑战，且与过量用药和死亡风险增加有关。在此，我们回顾一个多学科项目，该项目旨在在美国俄勒冈州实施并评估基于诊所的干预措施，以改善疼痛管理、阿片类药物处方开具及OUD治疗。这项名为“改善初级保健中的疼痛与阿片类药物管理”（PINPOINT）的干预措施，通过俄勒冈州远程医疗网络（ECHO），将实践促进、学术详述和教育结合起来。PINPOINT已在俄勒冈农村基于实践的研究网络中实施，迄今为止已涉及49个诊所。为评估该干预措施的影响，研究团队创建了“阿片类药物管理与处方培训提供者结果”（PROMPT）数据集，该数据集将来自州处方药监测项目、全支付方索赔数据库、紧急医疗服务、生命记录和物质使用障碍治疗系统的信息联系起来。PROMPT数据集将有助于评估该干预措施在临床医生和诊所层面的影响。由于新冠疫情的限制，实施和评估的各个环节都需要进行重大调整，以继续实现最初的项目目标。
