Targeting Effective Analgesia in Clinics for HIV - Intervention (TEACH)
Collaborative Care Intervention to Improve Providers' Opioid Prescribing for HIV-infected Patients - Intervention Component
研究概览
地位
详细说明
The "Targeting Effective Analgesia in Clinics for HIV" (TEACH) Study will test the effectiveness of a collaborative care intervention directed toward HIV physicians to improve the management of chronic opioid therapy (COT) and reduce the misuse of prescription opioids among HIV-infected persons.
The intervention is composed of the following elements: 1) collaboration with an IT enabled nurse care manager; 2) physician education and academic detailing; and 3) facilitated access to a specialist in addictions to help manage the most challenging HIV-infected patients on COT. The nurse care manager will utilize an electronic registry to assist physicians in implementing guideline-driven care including opioid treatment agreements, urine drug testing (UDT), random pill counts and checking of online Prescription Monitoring Programs (PMPs). Physicians in the control group will receive information summarizing guidelines for COT but will not have access to the support of the TEACH intervention. This study is multi-site and will be conducted at Boston Medical Center and Grady Hospital (teaching hospital of Emory University). The 2-site study will use a cluster randomized trial design, randomized at the level of the physician, and compare primary outcomes over one year. The Specific Aims are to test the effectiveness of the TEACH collaborative care program to achieve the following: Aim 1 - to test whether the TEACH collaborative care program improves HIV physicians' adherence to guidelines for prescribing COT compared to standard practice; Aim 2 - to assess whether patient level outcomes improve as a result of the TEACH intervention; Aim 3 - to test whether the intervention increases HIV physicians' satisfaction with prescribing COT; and Aim 4 - to assess whether the intervention improves virologic control among HIV-infected patients who are on COT. If effective, implementation of the intervention in HIV clinics will enable physicians in clinical teams to deliver chronic opioid therapy according to established guidelines with more confidence, potentially resulting in less prescription drug abuse and improved HIV outcomes.
There are two distinct components to the study. The intervention, outlined in this Clinical Trials Protocol Registration and Results System (PRS) summary, involves consenting physicians as participants in a randomized controlled trial of an intervention and, via a waiver of informed consent, extracting patient level data on the physicians' patients from the electronic medical record. The patient cohort component, which is outlined in a separate Clinical Trials PRS summary, will involve recruiting and consenting patients in the HIV clinic on COT to be participants in an observational study, which will involve interviewing them to collect self-reported data and conducting medical chart reviews.
If effective, implementation of the TEACH intervention in clinics will enable physicians who provide primary care to HIV-infected patients in clinical teams to deliver chronic opioid therapy according to established guidelines with more confidence, potentially resulting in less prescription drug abuse and improved HIV outcomes.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Georgia
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Atlanta、Georgia、美国、30322
- Emory University
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Massachusetts
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Boston、Massachusetts、美国、02118
- Boston Medical Center
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Physician Inclusion Criteria:
- Physician (i.e. MD, DO) or Advanced Practice Provider (i.e., Nurse Practitioner or Physicians Assistant) at enrollment sites.
- Main provider for ≥ 1 HIV-infected patient on COT (defined as having received ≥ 3 opioid prescriptions at least 21 days apart within a 6 month period).
Physician Exclusion Criteria:
- Investigator on this study.
- Planning to leave clinic < 9 months from enrollment.
Patient Inclusion Criteria:
- COT patient ages ≥ 18 who are patients of physicians enrolled in the TEACH study.
Patient Exclusion Criteria:
- None
学习计划
研究是如何设计的?
设计细节
- 主要用途:卫生服务研究
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:TEACH Collaborative Care Intervention
Physicians randomized to the intervention will receive: 1) collaboration with an IT enabled nurse care manager; 2) physician education and academic detailing; and 3) facilitated access to a specialist in addictions to help manage the most challenging HIV-infected patients on COT.
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The nurse care manager at each site will collaborate with intervention physicians to implement key essential elements of guideline driven care, namely opioid treatment agreements, urine drug testing, random pill counts and periodic checking of on-line Prescription Monitoring Programs.
The nurse care manager will use an electronic registry to retrieve pain medication information from the electronic medical record (EMR).
Registry data will be collected on the patients of the intervention group providers.
The nurse care manager will be able to use the registry to generate reports that will allow him/her to monitor those patients who are receiving opioids for chronic pain.
All intervention participants will receive a 60 minute group didactic session by a national expert on opioid prescribing for pain.
Physicians will receive two academic detailing sessions, and will be given the option of having a third, booster academic detailing session if desired.
The nurse care manager will encourage and arrange referral of challenging patients with potential abuse or dependence to prescription opioids to an addiction specialist.
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无干预:Standard of Care Control
Physicians in the control group will receive information summarizing guidelines for COT but will not have access to the support of the TEACH intervention.
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研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
---|---|
Patient receipt of ≥2 UDT (Electronic Medical Record (EMR) extraction)
大体时间:12 Months
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12 Months
|
% of patients who have ≥1 early refill (i.e., any early refills) (EMR extraction)
大体时间:12 Months
|
12 Months
|
Physician satisfaction managing HIV-infected patients on COT for pain (Physician self-report)
大体时间:12 Months
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12 Months
|
次要结果测量
结果测量 |
大体时间 |
---|---|
≥3 primary care visits in infectious disease clinic (EMR extraction)
大体时间:12 Months
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12 Months
|
% of patients who had a discontinuation of their narcotic prescriptions (EMR extraction)
大体时间:12 Months
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12 Months
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Opioid treatment agreement (EMR extraction)
大体时间:12 Months
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12 Months
|
% of physicians who self-report consulting the state Prescription Monitoring Program (Physician self-report)
大体时间:12 Months
|
12 Months
|
Number (continuous measure) of early refills at 12 months (EMR extraction)
大体时间:12 Months
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12 Months
|
Patient aberrant use (Patient self-report)
大体时间:12 Months
|
12 Months
|
Number of patients who have visited the emergency department to seek opioids (EMR extraction and patient self-report)
大体时间:12 Months
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12 Months
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Patient pain severity and interference (Patient self-report)
大体时间:12 Months
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12 Months
|
Patient addiction severity (Patient self-report)
大体时间:12 Months
|
12 Months
|
Physician confidence in prescribing COT (Physician self-report)
大体时间:12 Months
|
12 Months
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Patient satisfaction with COT (Patient self-report)
大体时间:12 Months
|
12 Months
|
Patient trust in physician (Patient self-report)
大体时间:12 Months
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12 Months
|
其他结果措施
结果测量 |
大体时间 |
---|---|
Undetectable HIV viral load (EMR extraction)
大体时间:12 Months
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12 Months
|
Cluster of differentiation 4 (CD4) cell count (EMR extraction)
大体时间:12 Months
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12 Months
|
合作者和调查者
调查人员
- 首席研究员:Jeffrey Samet, MD, MA, MPH、Boston Medical Center
- 首席研究员:Carlos del Rio, MD、Emory University
出版物和有用的链接
一般刊物
- Ngo B, Liebschutz JM, Cheng DM, Colasanti JA, Merlin JS, Armstrong WS, Forman LS, Lira MC, Samet JH, Del Rio C, Tsui JI. Hazardous alcohol use is associated with greater pain interference and prescription opioid misuse among persons living with HIV and chronic pain. BMC Public Health. 2021 Mar 22;21(1):564. doi: 10.1186/s12889-021-10566-6.
- Lira MC, Tsui JI, Liebschutz JM, Colasanti J, Root C, Cheng DM, Walley AY, Sullivan M, Shanahan C, O'Connor K, Abrams C, Forman LS, Chaisson C, Bridden C, Podolsky MC, Outlaw K, Harris CE, Armstrong WS, Del Rio C, Samet JH. Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study - a cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV. HIV Res Clin Pract. 2019 Apr;20(2):48-63. doi: 10.1080/15284336.2019.1627509.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.
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