- ICH GCP
- Registro degli studi clinici negli Stati Uniti
- Sperimentazione clinica NCT02433496
Physician Coaching to Reduce Opioid-related Harms
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Descrizione dettagliata
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.
Tipo di studio
Iscrizione (Effettivo)
Contatti e Sedi
Luoghi di studio
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Wisconsin
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Madison, Wisconsin, Stati Uniti, 53705
- University of Wisconsin - Madison
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Metodo di campionamento
Popolazione di studio
Descrizione
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.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
Coorti e interventi
Gruppo / Coorte |
Intervento / Trattamento |
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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.
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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.
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Overall Rate of Opioid Prescribing
Lasso di tempo: Up to 3 years
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The proportion of patients with a chronic pain diagnosis receiving daily opioids.
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Up to 3 years
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
---|---|---|
Rate of Opioid / Benzodiazepine Co-prescribing
Lasso di tempo: Up to 3 years
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Proportion of patients with a chronic pain diagnosis receiving daily opioids and benzodiazepines concurrently.
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Up to 3 years
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Urine Drug Screening Rate
Lasso di tempo: Up to 3 years
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Proportion of opioid patients completing urine drug screens prior to and during the study intervention
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Up to 3 years
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Mental Health Screening Rate
Lasso di tempo: Up to 3 years
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Proportion of opioid patients screened for mental health/substance use problems
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Up to 3 years
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Use of Pain Management Agreements
Lasso di tempo: Up to 3 years
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Proportion of opioid patients signing pain management agreements
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Up to 3 years
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High-dose Patients
Lasso di tempo: Up to 3 years
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Proportion of opioid prescriptions above 120 mg daily morphine equivalent
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Up to 3 years
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Provider Drop-out Rate
Lasso di tempo: 3 months
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Number and percentage of providers who drop out of study at 3 months
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3 months
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Participating Patient Demographics
Lasso di tempo: Up to 3 years
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Characteristics of participating patients vs. general patient population (race, gender, ethnicity)
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Up to 3 years
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Participating Clinic Characteristics
Lasso di tempo: Up to 12 months
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Characteristics of participating clinics vs. non-participating clinics (number of patients, number of providers, overall opioid prescribing rate)
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Up to 12 months
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Participating Staff Characteristics
Lasso di tempo: Up to 12 months
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Characteristics of participating staff (profession)
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Up to 12 months
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Intervention Fidelity
Lasso di tempo: Up to 12 months
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Total hours of coaching delivered/received among all clinics that received physician coaching.
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Up to 12 months
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Intervention Cost
Lasso di tempo: Up to 12 months
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Total cost of coaching intervention among all clinics that received physician coaching.
At clinic level.
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Up to 12 months
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Proportion With MEDD >120 mg
Lasso di tempo: Up to 12 months
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The proportion of patients who have consistent opioid Rx above a morphine equivalent daily dose about 120 mg.
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Up to 12 months
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Average Morphine Equivalent Daily Dose (MEDD)
Lasso di tempo: Up to 12 months
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The average MEDD in milligrams for patients with consistent opioid Rx.
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Up to 12 months
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Collaboratori e investigatori
Sponsor
Investigatori
- Investigatore principale: Andrew R Quanbeck, PhD, Center for Health Enhancement Systems Studies
Pubblicazioni e link utili
Studiare le date dei record
Studia le date principali
Inizio studio
Completamento primario (Effettivo)
Completamento dello studio (Effettivo)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stima)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- 2015-0280
- 1R34DA036720-01A1 (Sovvenzione/contratto NIH degli Stati Uniti)
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .
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