Physician Coaching to Reduce Opioid-related Harms

Completed

Conditions: Chronic Pain
Substance Abuse

Interventions: Other: Physician coaching

Registration Number: NCT02433496

Lead Sponsor: University of Wisconsin, Madison

Brief Summary: 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.

Detailed Description: 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.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 53132

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.

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Physician coaching	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.

Primary Outcome Measures

Name	Time	Method
Overall Rate of Opioid Prescribing	Up to 3 years	The proportion of patients with a chronic pain diagnosis receiving daily opioids.

Secondary Outcome Measures

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