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Physician Coaching to Reduce Opioid-related Harms

3. juli 2018 opdateret af: University of Wisconsin, Madison
This project pilot tests an innovative clinical guideline translation and physician coaching model to promote adherence to evidence-based guidelines for the prescribing of opioid pain medications in primary care settings.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

This project addresses the urgent need to promote the adoption of evidence-based practices in healthcare by pilot-testing an innovative implementation strategy. The implementation strategy aims primarily to reduce variation in opioid prescribing practices for chronic pain in primary care settings.

The standard approach to improving medical practice involves groups of clinical experts reviewing the literature to produce clinical guidelines based on scientific evidence, and disseminating those guidelines by publishing them in medical journals. A clinical guideline has been developed for opioid prescribing for chronic non-cancer pain using this type of approach. The implementation strategy for promoting uptake of the guideline in primary care settings tested in this study consists of three innovations: (1) a process for translating clinical guidelines into a checklist-based implementation guide for clinicians, (2) a physician peer coaching model, and (3) implementation support using tools from systems engineering. This project teams the experts who developed the guideline for opioid prescribing with experts in implementation science and primary care to translate the guideline into an actionable, checklist-based implementation guide. If the implementation strategy is effective in this pilot test, it will be used in a larger cluster-randomized trial to test it against other approaches to evidence-based practice adoption.The long-term goal of this research is to improve the adoption of evidence-based practices in primary care by producing a generalizable model of change.

Undersøgelsestype

Observationel

Tilmelding (Faktiske)

53132

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Wisconsin
      • Madison, Wisconsin, Forenede Stater, 53705
        • University of Wisconsin - Madison

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ja

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

Clinicians with prescribing authority at community-based primary care clinics

Beskrivelse

Inclusion Criteria:

At each of the 4 coaching intervention sites, we aim to recruit between 3-7 clinical care providers with prescribing authority (e.g., primary care physicians, mid-level practitioners, etc.) to participate in interviews and focus groups. All clinic staff (e.g., medical assistants, office staff) are welcome to participate in coaching site visits and follow up correspondence, but only staff with prescribing authority will be considered research participants.

Exclusion Criteria:

  • Residents will be excluded.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Kohorter og interventioner

Gruppe / kohorte
Intervention / Behandling
Physician coaching
This group includes 4 intervention primary care clinics that are part of the University of Wisconsin's Department of Family Medicine. These clinics will receive an organizational coaching intervention that includes in-person site visits and phone/email communication. Each participating clinic will designate one primary care physician to act as a clinic lead in working with the coach to coordinate an initial site visit (during project month 13, July 2015), a follow-up site visit (month 15, October, 2015), and communicating with the coach throughout the 6-month follow-up period via phone and email.
Andet: Physician coaching

The coach will present the latest research on the benefits and risks of long-term opioid use. The presentation will be followed by a brainstorming exercise where the coach joins the clinic team in experiencing clinical practices from the perspective of a patient with chronic pain. The coach will help the clinic team flowchart clinical workflows and determine the best course for implementing aspects of a checklist-based implementation guide developed to support adoption of the guidelines for opioid prescribing.

The coach will help the team implement ideas using Plan-Do-Study-Act change cycles. The coach will maintain monthly email and phone contact with the clinic lead and clinic team after the initial site visit to monitor implementation progress and offer advice.
Control Group
This group includes 4 control primary care clinics that will not receive any intervention. A de-identified dataset will be created to examine differences in outcome variables between intervention and control clinics.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Overall Rate of Opioid Prescribing
Tidsramme: Up to 3 years
The proportion of patients with a chronic pain diagnosis receiving daily opioids.
Up to 3 years

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Rate of Opioid / Benzodiazepine Co-prescribing
Tidsramme: Up to 3 years
Proportion of patients with a chronic pain diagnosis receiving daily opioids and benzodiazepines concurrently.
Up to 3 years
Urine Drug Screening Rate
Tidsramme: Up to 3 years
Proportion of opioid patients completing urine drug screens prior to and during the study intervention
Up to 3 years
Mental Health Screening Rate
Tidsramme: Up to 3 years
Proportion of opioid patients screened for mental health/substance use problems
Up to 3 years
Use of Pain Management Agreements
Tidsramme: Up to 3 years
Proportion of opioid patients signing pain management agreements
Up to 3 years
High-dose Patients
Tidsramme: Up to 3 years
Proportion of opioid prescriptions above 120 mg daily morphine equivalent
Up to 3 years
Provider Drop-out Rate
Tidsramme: 3 months
Number and percentage of providers who drop out of study at 3 months
3 months
Participating Patient Demographics
Tidsramme: Up to 3 years
Characteristics of participating patients vs. general patient population (race, gender, ethnicity)
Up to 3 years
Participating Clinic Characteristics
Tidsramme: Up to 12 months
Characteristics of participating clinics vs. non-participating clinics (number of patients, number of providers, overall opioid prescribing rate)
Up to 12 months
Participating Staff Characteristics
Tidsramme: Up to 12 months
Characteristics of participating staff (profession)
Up to 12 months
Intervention Fidelity
Tidsramme: Up to 12 months
Total hours of coaching delivered/received among all clinics that received physician coaching.
Up to 12 months
Intervention Cost
Tidsramme: Up to 12 months
Total cost of coaching intervention among all clinics that received physician coaching. At clinic level.
Up to 12 months
Proportion With MEDD >120 mg
Tidsramme: Up to 12 months
The proportion of patients who have consistent opioid Rx above a morphine equivalent daily dose about 120 mg.
Up to 12 months
Average Morphine Equivalent Daily Dose (MEDD)
Tidsramme: Up to 12 months
The average MEDD in milligrams for patients with consistent opioid Rx.
Up to 12 months

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

University of Wisconsin, Madison

Samarbejdspartnere

National Institute on Drug Abuse (NIDA)
Center for Health Enhancement System Studies

Efterforskere

  • Ledende efterforsker: Andrew R Quanbeck, PhD, Center for Health Enhancement Systems Studies

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. juli 2014

Primær færdiggørelse (Faktiske)

30. juni 2017

Studieafslutning (Faktiske)

30. juni 2017

Datoer for studieregistrering

Først indsendt

20. april 2015

Først indsendt, der opfyldte QC-kriterier

29. april 2015

Først opslået (Skøn)

5. maj 2015

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

6. juli 2018

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

3. juli 2018

Sidst verificeret

1. juli 2018

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 2015-0280
  • 1R34DA036720-01A1 (U.S. NIH-bevilling/kontrakt)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

Kliniske forsøg med Kronisk smerte

Kliniske forsøg med Physician coaching

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