Toward Safer Opioid Prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial

Autor: Gabriela Cedillo, Mary Catherine George, Richa Deshpande, Emma K. T. Benn, Allison Navis, Alexandra Nmashie, Alina Siddiqui, Bridget R. Mueller, Yosuke Chikamoto, Linda Weiss, Maya Scherer, Alexandra Kamler, Judith A. Aberg, Barbara G. Vickrey, Angela Bryan, Brady Horn, Angela Starkweather, Jeffrey Fisher, Jessica Robinson-Papp
Rok vydání: 2021
Předmět:
Zdroj: Addiction scienceclinical practice. 17(1)
ISSN: 1940-0640
0366-9939
Popis: Background The 2016 U.S. Centers for Disease Control Opioid Prescribing Guideline (CDC Guideline) is currently being revised amid concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). However, a methodology to faithfully implement the CDC guideline, measure prescriber adherence, and systematically test its effect on patient and public health outcomes is lacking. We developed and tested a CDC Guideline implementation strategy (termed TOWER), focusing on an outpatient HIV-focused primary care setting. Methods TOWER was developed in a stakeholder-engaged, multi-step iterative process within an Information, Motivation and Behavioral Skills (IMB) framework of behavior change. TOWER consists of: 1) a patient-facing opioid management app (OM-App); 2) a progress note template (OM-Note) to guide the office visit; and 3) a primary care provider (PCP) training. TOWER was evaluated in a 9-month, randomized-controlled trial of HIV-PCPs (N = 11) and their patients with HIV and CP-LTOT (N = 40). The primary outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the validated Safer Opioid Prescribing Evaluation Tool (SOPET). Qualitative data including one-on-one PCP interviews were collected. We also piloted patient-reported outcome measures (PROMs) reflective of domains identified as important by stakeholders (pain intensity and function; mood; substance use; medication use and adherence; relationship with provider; stigma and discrimination). Results PCPs randomized to TOWER were 48% more CDC Guideline adherent (p Conclusions CDC-guideline adherence can be promoted and measured, and is not associated with worsening of outcomes for people with HIV receiving LTOT for CP. Future work would be needed to document scalability of these results and to determine whether CDC-guideline adherence results in a positive effect on public health. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03669939. Registration date: 9/13/2018
Databáze: OpenAIRE
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