Kari Stephens on opioid management

Kari Stephens, IBHPC coinvestigator, has a new paper out from another project. Congratulations, Kari!

Challenges and Approaches to Population Management of Long-Term Opioid Therapy Patients

Kari A. Stephens, Brooke Ike, Laura-Mae Baldwin, Christine Packer and Michael Parchman

The Journal of the American Board of Family Medicine January 2021, 34 (1) 89-98; https://www.jabfm.org/content/34/1/89.abstract?etoc

Abstract

Purpose: Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. We identify sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines.

Methods: We examined qualitative data (field notes and postintervention interview and focus group transcripts) from 6 rural and rural-serving primary care organizations with 20 clinic locations enrolled in a study evaluating a practice redesign program to improve opioid medication management for CNCP patients. Two independent researchers used content analysis to categorize data into key themes to develop an understanding of sociotechnical factors critical to creating and implementing an approach to tracking and monitoring of patients on long-term opioid therapy in primary care practices.

Results: Four factors were critical to developing a tracking and monitoring system. For each we describe common challenges and approaches used by the clinics to overcome then. The first factor, buy-in and participation, was essential for accomplishing the other 3. The other factors occurred sequentially: 1) cohort identification—finding the right patients, 2) data collection and extraction—tracking the right data, and 3) data use—monitoring patients and adjusting care processes.

Conclusions: We identified common challenges and approaches to tracking and monitoring patients using long-term opioid therapy for CNCP in primary care. Based on these findings we provide recommendations to build capacity for tracking and monitoring for organizations that are engaged in improving safe opioid-prescribing practices for CNCP in primary care.

 

IBH-PC Methods Paper Now Available

The first major report from IBH-PC, a detailed presentation of the study methods to be referred to by following papers, is now available in preprint form. The study is under review at the journal Trials which posted it on ResearchSquare.com where the full text, figures and tables are available as HTML or PDF while they finish their review. Many thanks to Abby Crocker for leading this writing effort!

Crocker, AM., Kessler, R., van Eeghen, C. et al. Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial. 05 November 2020, PREPRINT (Version 1) available at Research Square https://doi.org/10.21203/rs.3.rs-54202/v1

ABSTRACT

Background

Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice’s degree of behavioral health integration.

Methods

43 primary care practices, with existing onsite behavioral health care, will be randomized to the intervention or usual care arm. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice’s degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.

Discussion

As primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.

 

- Ben Littenberg

Clinical Research Oriented Workshop (CROW) Meeting: November 5, 2020

 Present:   Levi Bonnell, Justine Dee, Nancy Gell, Juvena Hitt, Jen Oshita, Adam Sprouse-Blum, Connie van Eeghen, (7)

 1.                   Warm Up: These are interesting times…

2.                   Levi: three co-authors, he will take notes for them and is first author

a.       Title

                                                   i.      Is it cardiovascular capacity, or cardiorespiratory capacity, or functional capacity (O2 uptake)

1.       Should it be in milligrams/kilograms, rather than METs?  What does the audience understand?

2.       Use SDH or list food/housing/finance

b.       Abstract

                                                   i.      Specify population more; reconsider how the diagnoses are grouped (medical vs behavioral), especially IBS

                                                 ii.      Design: cross sectional

                                               iii.      Outcomes: be consistent; connect with DASI

                                               iv.      Use of “insecurities” to describe the environment; consistent use of SDH (plural noun?)

c.       Introduction

                                                   i.      More explanation of the relationship of predictors, outcomes, and co-variates

d.       General: floating negative signs, how to combine graphs well, avoid passive voice, other references, and a great discussion

3.                   Next week:  Levi will figure it out.