Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
Applied Research Collaboration North East and North Cumbria, NIHR, Gosforth, UK.
BMJ Open. 2023 Feb 6;13(2):e066158. doi: 10.1136/bmjopen-2022-066158.
Opioid prescribing rates are disproportionately high in the North of England. In addition to patients' complex health needs, clinician prescribing behaviour is also a key driver. Although strategies have been initiated to reduce opioid prescribing nationally, the COVID-19 pandemic has interrupted service provision and created challenges for the system and health professionals to tackle this complex issue. A pilot intervention using smartphone video messaging has been developed to remotely explain the rationale for opioid reduction and facilitate self-initiation of support. The aim of this study is to evaluate the potential benefits, risks and economic consequences of 'at scale' implementation.
This will be a mixed-methods study comprising a quasi-experimental non-randomised before-and-after study and qualitative interviews. The intervention arm will comprise 50 General Practitioner (GP) Practices using System 1 (a clinical computer system hosting the intervention) who will deliver the video to their patients via text message. The control arm will comprise 50 practices using EMIS (a different computer system) who will continue usual care. Monthly practice level prescribing and consultation data will be observed for 6 months postintervention. A general linear model will be used to estimate the association between the exposure and the main outcome (opioid prescribing; average daily quantity (ADQ)/1000 specific therapeutic group age-sex related prescribing unit). Semi-structured interviews will be undertaken remotely with purposively selected participants including patients who received the video, and health professionals involved in sending out the videos and providing additional support. Interviews will be audio recorded, transcribed and analysed thematically.
Ethics approval has been granted by the NHS Health Research Authority Research Ethics Committee (22/PR/0296). Findings will be disseminated to the participating sites, participants, and commissioners, and in peer-reviewed journals and academic conferences.
NCT05276089.
英格兰北部的阿片类药物处方率过高。除了患者复杂的健康需求外，临床医生的处方行为也是一个关键驱动因素。尽管已经在全国范围内启动了减少阿片类药物处方的策略，但 COVID-19 大流行中断了服务提供，并给系统和卫生专业人员带来了挑战，难以解决这一复杂问题。已经开发了一种使用智能手机视频消息的试点干预措施，以远程解释减少阿片类药物的基本原理，并为支持患者的自我启动提供便利。本研究的目的是评估“大规模”实施的潜在益处、风险和经济后果。
这将是一项混合方法研究，包括准实验性非随机前后研究和定性访谈。干预组将包括 50 家使用 System 1（托管干预措施的临床计算机系统）的全科医生（GP）实践，他们将通过短信向患者发送视频。对照组将包括 50 家使用 EMIS（另一个计算机系统）的实践，他们将继续常规护理。干预后 6 个月内将每月观察实践水平的处方和咨询数据。将使用一般线性模型估计暴露与主要结局（阿片类药物处方；特定治疗组年龄性别相关处方单位的平均每日剂量（ADQ）/1000）之间的关联。将远程对包括接受视频的患者在内的有针对性选择的参与者以及参与发送视频和提供额外支持的卫生专业人员进行半结构式访谈。访谈将进行录音、转录和主题分析。
已获得英国国民保健署健康研究局研究伦理委员会的伦理批准（22/PR/0296）。研究结果将分发给参与的地点、参与者和决策者，并发表在同行评议的期刊和学术会议上。
NCT05276089。
