Baltes Amelia, Horton David, Trevino Colleen, Quanbeck Andrew, Deyo Brienna, Nicholas Christopher, Brown Randall
Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Implement Res Pract. 2024 Feb 2;5:26334895231226193. doi: 10.1177/26334895231226193. eCollection 2024 Jan-Dec.
As the opioid crisis continues to affect communities across the United States, new interventions for screening and prevention are needed to mitigate its impact. Mental health diagnoses have been identified as a risk factor for opioid misuse, and surgical populations and injury survivors are at high risk for prolonged opioid use and misuse. This study investigated the implementation of a novel opioid risk screening tool that incorporated putative risk factors from a recent study in four trauma units across Wisconsin.
The screening tool was implemented across a 6-month period at four sites. Data was collected via monthly meeting notes and "Plan, Do, Study, Act" (PDSA) forms. Following implementation, focus groups reflected on the facilitators and barriers to implementation. Meeting notes, PDSA forms, and focus group data were analyzed using the consolidated framework for implementation research, followed by thematic analyses, to generate themes surrounding the facilitators and barriers to implementing an opioid misuse screener.
Implementation facilitators included ensuring patient understanding of the screener, minimizing staff burden from screening, and educating staff to encourage engagement. Barriers included infrastructure limitations that prevented seamless administration of the screener within current workflows, overlap of the screener with existing measures, and lack of guidance surrounding treatment options corresponding to risk. Recommended solutions to address barriers include careful timing of screener administration, accommodating workflows, integration of the screening tool within the electronic health record, and evidence-based interventions guided by screener results.
Four trauma centers across Wisconsin successfully implemented a pilot opioid misuse screening tool. Trauma providers and unit staff members believe that this tool would be a beneficial addition to their repertoire if their recommendations were adopted. Future research should refine opioid misuse risk factors and ensure screening items are well-validated with psychometric research supporting treatment responses to screener-indicated risk categories.
随着阿片类药物危机继续影响美国各地的社区，需要新的筛查和预防干预措施来减轻其影响。心理健康诊断已被确定为阿片类药物滥用的一个风险因素，手术人群和受伤幸存者长期使用和滥用阿片类药物的风险很高。本研究调查了一种新型阿片类药物风险筛查工具的实施情况，该工具纳入了威斯康星州四个创伤中心最近一项研究中的假定风险因素。
该筛查工具在四个地点进行了为期6个月的实施。通过月度会议记录和“计划、执行、研究、行动”（PDSA）表格收集数据。实施后，焦点小组反思了实施的促进因素和障碍。使用实施研究的综合框架对会议记录、PDSA表格和焦点小组数据进行分析，随后进行主题分析，以生成围绕实施阿片类药物滥用筛查工具的促进因素和障碍的主题。
实施促进因素包括确保患者理解筛查工具、尽量减少筛查给工作人员带来的负担，以及对工作人员进行教育以鼓励他们参与。障碍包括基础设施限制，这妨碍了在当前工作流程中无缝实施筛查工具、筛查工具与现有措施的重叠，以及缺乏与风险相对应的治疗选择的指导。针对障碍的建议解决方案包括仔细安排筛查工具的实施时间、适应工作流程、将筛查工具整合到电子健康记录中，以及以筛查结果为指导的循证干预措施。
威斯康星州的四个创伤中心成功实施了一项阿片类药物滥用筛查工具试点项目。创伤提供者和科室工作人员认为，如果他们的建议得到采纳，该工具将是他们工具库中的一项有益补充。未来的研究应完善阿片类药物滥用风险因素，并确保筛查项目经过充分验证，同时有心理测量学研究支持针对筛查显示的风险类别的治疗反应。
