Evidence-Based Interventions to Improve Opioid Prescribing in Primary Care: a Qualitative Assessment of Implementation in Two Studies.

Autor: Carroll JJ; Department of Sociology and Anthropology, North Carolina State University, Raleigh, NC, USA. Jjcarro3@ncsu.edu.; Warren Alpert School of Medicine, Brown University, Providence, RI, USA. Jjcarro3@ncsu.edu., Cushman PA; Department of Medicine, UMass Chan Medical School, Worcester, MA, USA., Lira MC; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA., Colasanti JA; Division of Infectious Diseases, Emory University, Atlanta, GA, USA.; Grady Health System, Atlanta, GA, USA., Del Rio C; Division of Infectious Diseases, Emory University, Atlanta, GA, USA.; Grady Health System, Atlanta, GA, USA., Lasser KE; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA.; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA., Parker V; Department of Management, Peter. T. Paul College of Business & Economics, University of New Hampshire, Durham, NH, USA., Roy PJ; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Samet JH; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA., Liebschutz JM; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2023 Jun; Vol. 38 (8), pp. 1794-1801. Date of Electronic Publication: 2022 Nov 17.
DOI: 10.1007/s11606-022-07909-3
Abstrakt: Background: The TOPCARE and TEACH randomized controlled trials demonstrated the efficacy of a multi-faceted intervention to promote guideline-adherent long-term opioid therapy (LTOT) in primary care settings. Intervention components included a full-time Nurse Care Manager (NCM), an electronic registry, and academic detailing sessions.
Objective: This study sought to identify barriers, facilitators, and other issues germane to the wider implementation of this intervention.
Design: We conducted a nested, qualitative study at 4 primary care clinics (TOPCARE) and 2 HIV primary care clinics (TEACH), where the trials had been conducted.
Approach: We purposively sampled primary care physicians and advanced practice providers (hereafter: PCPs) who had received the intervention. Semi-structured interviews explored perceptions of the intervention to identify unanticipated barriers to and facilitators of implementation. Interview transcripts were analyzed through iterative deductive and inductive coding exercises.
Key Results: We interviewed 32 intervention participants, 30 physicians and 2 advanced practice providers, who were majority White (66%) and female (63%). Acceptability of the intervention was high, with most PCPs valuing didactic and team-based intervention elements, especially co-management of LTOT patients with the NCM. Adoption of new prescribing practices was facilitated by proximity to expertise, available behavioral health care, and the NCM's support. Most participants were enthusiastic about the intervention, though a minority voiced concerns about the appropriateness in their particular clinical environments, threats to the patient-provider relationship, or long-term sustainability.
Conclusion: TOPCARE/TEACH participants found the intervention generally acceptable, appropriate, and easy to adopt in a variety of primary care environments, though some challenges were identified. Careful attention to the practical challenges of implementation and the professional relationships affected by the intervention may facilitate implementation and sustainability.
(© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Databáze: MEDLINE
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