Improving Opioid Safety in Veterans Using Collaborative Care and Decision Support
Overview
- Phase
- Phase 1
- Intervention
- Not specified
- Conditions
- Chronic Pain
- Sponsor
- San Francisco Veterans Affairs Medical Center
- Enrollment
- 100
- Locations
- 1
- Primary Endpoint
- To evaluate the feasibility, acceptability, and usability of augmenting ATHENA-OT decision support with a Collaborative Care intervention.
- Status
- Completed
- Last Updated
- 8 years ago
Overview
Brief Summary
The investigators propose to develop a novel intervention that targets the system (Collaborative Care), PCP (computerized decision support for opioid therapy) and veteran (CM-delivered MI) to reduce problematic prescription opioid use and encourage non-opioid pain management alternatives.
Detailed Description
The investigators will develop and test the acceptability, feasibility, and preliminary efficacy of a Collaborative Care intervention in which one of two Care Managers delivering both interventions will assist primary care providers (PCPs) by using Motivational Interviewing to communicate computer-based ATHENA-OT (opioid therapy) decision support guidelines to veterans with chronic pain. Specifically, after honing the intervention, the investigators will conduct a pilot randomized controlled trial of Collaborative Care/Motivational Interviewing in 100 veterans (ages 18 and older) with chronic pain in primary care who are prescribed opioid pain medications and exhibit at least one "high-risk" opioid use behavior (e.g. obtaining early opioid refills, etc.). Using ATHENA-OT decision support, PCPs will make guideline-concordant recommendations to all enrolled study patients and initiate a Pain Care Plan. Veterans randomized to Collaborative Care, will have one MI session with their assigned study Care Manager followed by 3 Care Manager-delivered telephone MI/monitoring sessions; patients randomized to the Attention Control arm will have one brief session with their assigned Care Manager, followed by 3 Care Manager-delivered neutral telephone sessions
Investigators
Karen Seal
Principal Investigator
San Francisco Veterans Affairs Medical Center
Eligibility Criteria
Inclusion Criteria
- •Current Male or Female patient at San Francisco VA Medical Center or affiliated VA clinics
- •Must be older than 18 years
- •Chronic musculoskeletal pain of at least 6 months duration and
- •Prescribed one or more opioid pain medication for more than three months and
- •Evidence of being a high-risk opioid user as determined by PI, electronic medical record, and study measures
Exclusion Criteria
- •Non-English speakers
- •Plans to relocate within 6 months; not able to come to San Francisco VA Medical Center for three in-person visits
- •Cancer or other terminal illness involving palliative care with opioid medications
- •Serious or untreated mental illness
Outcomes
Primary Outcomes
To evaluate the feasibility, acceptability, and usability of augmenting ATHENA-OT decision support with a Collaborative Care intervention.
Time Frame: 20 weeks post baseline
* PCPs and the CM in the Collaborative Care arm will report greater self-efficacy in communicating ATHENA-OT pain management recommendations and in developing a Pain Care Plan with chronic pain patients * The CM will conduct MI communication with high fidelity. * Veterans in the Collaborative Care arm will report greater satisfaction with pain-related care.
Secondary Outcomes
- To preliminarily evaluate the efficacy of ATHENA-OT decision support plus Collaborative Care (CC) to improve prescription opioid safety and adherence to non-opioid pain management alternatives among primary care patients.(20 weeks post baseline)