Black Anne C, Edmond Sara N, Frank Joseph W, Abelleira Audrey, Snow Jennifer L, Wesolowicz Danielle M, Becker William C
VA Connecticut Healthcare System, West Haven, CT, USA.
Yale School of Medicine, New Haven, CT, USA.
Subst Use Addctn J. 2025 Jan;46(1):155-159. doi: 10.1177/29767342241236032. Epub 2024 Mar 12.
Guidelines recommend strategies to optimize opioid medication safety, including frequent reassessment of the benefits and harms of long-term opioid therapy. Prescribers, who are predominantly primary care providers (PCPs), may lack the training or resources to implement these guideline-concordant practices. Two interventions have been designed to assist PCPs and tested within the Veterans Health Administration (VHA). Telemedicine Collaborative Management (TCM) provides primarily medication management support via care manager-prescriber teams. Cooperative Pain Education and Self-Management (COPES) promotes self-management strategies for chronic pain via cognitive behavior therapy techniques. Each intervention has been shown to improve prescribing and/or patient outcomes. The added value of combining these interventions is untested. With funding and central coordination by the Integrative Management of Chronic Pain and Opioid Use Disorder for Whole Recovery (IMPOWR) Network of the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative, we will conduct a multisite patient-level randomized hybrid II effectiveness-implementation trial within VHA to compare TCM to TCM + COPES on the primary composite outcome of pain interference and opioid safety, secondary outcomes of alcohol use, anxiety, depression, and sleep, and other consensus IMPOWR Network measures. Implementation facilitation strategies informed by interviews with healthcare providers will target site-specific needs. The impact of these strategies on TCM implementation will be assessed via established formative and summative evaluation techniques. Economic analyses will evaluate intervention cost-effectiveness.
指南推荐了优化阿片类药物用药安全的策略，包括对长期阿片类药物治疗的益处和危害进行频繁重新评估。开处方者主要是初级保健提供者（PCP），他们可能缺乏实施这些符合指南做法的培训或资源。已经设计了两种干预措施来协助初级保健提供者，并在退伍军人健康管理局（VHA）内进行了测试。远程医疗协作管理（TCM）主要通过护理经理-开处方者团队提供药物管理支持。合作疼痛教育与自我管理（COPES）通过认知行为治疗技术促进慢性疼痛的自我管理策略。每种干预措施都已显示出能改善处方开具和/或患者预后。将这些干预措施结合起来的附加价值尚未得到检验。在美国国立卫生研究院“助力长期终结成瘾”（HEAL）倡议的慢性疼痛与阿片类药物使用障碍综合管理（IMPOWR）网络的资助和中央协调下，我们将在VHA内开展一项多中心患者层面的随机混合II期有效性-实施试验，以比较TCM与TCM + COPES在疼痛干扰和阿片类药物安全这一主要综合结局、酒精使用、焦虑、抑郁和睡眠等次要结局以及IMPOWR网络其他共识性指标方面的效果。通过与医疗保健提供者的访谈得出的实施促进策略将针对特定地点的需求。这些策略对TCM实施的影响将通过既定的形成性和总结性评估技术进行评估。经济分析将评估干预措施的成本效益。
