基于创伤中心的项目实施经验，以支持初级保健提供者管理创伤住院后的阿片类药物和疼痛。
Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization.
作者信息
Baldwin Laura-Mae, Katers Laura A, Sullivan Mark D, Gordon Debra B, James Adrienne, Tauben David J, Arbabi Saman
机构信息
Department of Family Medicine and the Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA.
Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA.
出版信息
Trauma Surg Acute Care Open. 2023 Feb 20;8(1):e001038. doi: 10.1136/tsaco-2022-001038. eCollection 2023.
BACKGROUND
Decreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients.
METHODS
This longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP's identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support.
RESULTS
The PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP's office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were.
CONCLUSIONS
This level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma.
LEVEL OF EVIDENCE
Level IV.
背景
减少处方阿片类药物的使用对于降低阿片类药物滥用、过量使用及阿片类药物使用障碍的风险至关重要。本研究报告了一项随机对照试验的二次分析，该试验实施了一项阿片类药物减量支持计划，针对从一级创伤中心出院后返回家中且住所距该中心较远的患者的初级保健提供者（PCP），并分享了创伤中心在支持这些患者方面的经验教训。
方法
这项纵向描述性混合方法研究使用来自试验干预组患者的定量/定性数据，以检查实施挑战和结果：采用情况、可接受性、适当性、可行性、保真度。在干预过程中，一名医师助理（PA）在患者出院后与其联系，以审查出院指导和疼痛管理计划，确认其初级保健提供者的身份，并鼓励初级保健提供者进行随访。该医师助理与初级保健提供者联系，以审查出院指导，并提供持续的阿片类药物减量和疼痛管理支持。
结果
该医师助理联系了随机分配到该计划的37名患者中的32名。在这32名患者中，81%讨论了干预未针对的主题（如社会/财务问题）。该医师助理仅为51%的患者找到了并联系上了初级保健提供者的办公室。在这些办公室中，所有初级保健提供者办公室（100%采用率）每位患者收到一至四次咨询（平均1.9次）（保真度）。很少有咨询是与初级保健提供者进行的（22%）；大多数是与医疗助理（56%）或护士（22%）进行的。该医师助理报告称，对于患者或初级保健提供者来说，通常不清楚谁负责创伤后护理和阿片类药物减量，以及减量指导是什么。
结论
这家一级创伤中心在新冠疫情期间成功实施了一项电话阿片类药物减量支持计划，但对该计划进行了调整，以便护士和医疗助理能够接收相关信息。本研究表明，迫切需要改善创伤后出院患者从住院到家庭的护理过渡。
证据级别
四级。
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