Improving the Delivery of Chronic Opioid Therapy Among People Living With Human Immunodeficiency Virus: A Cluster Randomized Clinical Trial
| Autor: | Christopher W. Shanahan, Jeffrey H. Samet, Kishna Outlaw, Wendy S. Armstrong, Christin Root, Margaret M. Sullivan, Alexander Y. Walley, Marlene C. Lira, Carly Bridden, Carlos del Rio, Catherine E. Harris, Judith I. Tsui, Jonathan Colasanti, Jane M. Liebschutz, Catherine Abrams, Leah S Forman, Debbie M. Cheng |
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| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty HIV Infections law.invention Academic detailing 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans Pain Management 030212 general & internal medicine Online Only Articles business.industry Medical record Chronic pain HIV Odds ratio medicine.disease Confidence interval Analgesics Opioid Clinical trial Infectious Diseases Chronic Pain business Viral load 030217 neurology & neurosurgery |
| Zdroj: | Clin Infect Dis |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background Chronic pain is prevalent among people living with human immunodeficiency virus (PLWH); managing pain with chronic opioid therapy (COT) is common. Human immunodeficiency virus (HIV) providers often diverge from prescribing guidelines. Methods This 2-arm, unblinded, cluster-randomized clinical trial assessed whether the Targeting Effective Analgesia in Clinics for HIV (TEACH) intervention improves guideline-concordant care compared to usual care for PLWH on COT. The trial was implemented from 2015 to 2018 with 12-month follow-up at safety-net hospital–based HIV clinics in Boston and Atlanta. We enrolled 41 providers and their 187 patients on COT. Prescribers were randomized 1:1 to either a 12-month intervention consisting of a nurse care manager with an interactive electronic registry, opioid education, academic detailing, and access to addiction specialists or a control condition consisting of usual care. Two primary outcomes were assessed through electronic medical records: ≥2 urine drug tests and any early COT refills by 12 months. Other outcomes included possible adverse consequences. Results At 12 months, the TEACH intervention arm had higher odds of ≥2 urine drug tests than the usual care arm (71% vs 20%; adjusted odds ratio [AOR], 13.38 [95% confidence interval {CI}, 5.85–30.60]; P < .0001). We did not detect a statistically significant difference in early refills (22% vs 30%; AOR, 0.55 [95% CI, .26–1.15]; P = .11), pain severity (6.30 vs 5.76; adjusted mean difference, 0.10 [95% CI, −1.56 to 1.75]; P = .91), or HIV viral load suppression (86.9% vs 82.1%; AOR, 1.21 [95% CI, .47–3.09]; P = .69). Conclusions TEACH is a promising intervention to improve adherence to COT guidelines without evident adverse consequences. |
| Databáze: | OpenAIRE |
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