To help stem the epidemic of opioid analgesic misuse, addiction, and overdose, professional pain societiesand regulatory agencies recommend that physicians implement opioid treatment agreements (OTAs) to definetreatment and monitoring plans for patients prescribed long-term opioid analgesics for chronic pain. Thoughprimary care physicians infrequently implement OTAs, little is known about their barriers to and facilitators ofOTA implementation, or about interventions to improve OTA implementation in primary care settings.
The specific aims of this Mentored Patient-Oriented Research Career Development Award application are:(1) to identify barriers to and facilitators of OTA implementation among primary care physicians, (2) to developa theory-guided intervention to promote OTA implementation in primary care, and (3) to determine whether atheory-guided intervention is associated with changes in OTA implementation in primary care. To achievethese aims, we will conduct semi-structured interviews with primary care physicians using the Theory ofReasoned Action / Theory of Planned Behavior as a theoretical framework, and an example OTA document asa prompt. Based on our findings, we will develop a theory-guided intervention to promote OTA implementation,and then refine it through pretesting and iterative feedback from primary care physicians. We expect that theintervention will include a tailored OTA document as well as components that support OTA implementation,including a two-part physician training, a reference guide, and quarterly case conferences. Finally, we willconduct a 12-month pilot study of the intervention in two large urban primary care practices. We will conductpre-post analyses using electronic medical record data to determine whether the intervention is associated withchanges in the use of OTA documents or urine drug testing, a key element of the monitoring strategy definedby OTAs. The knowledge gained from this proposal will inform future research and quality improvementinitiatives to promote responsible opioid prescribing in primary care. The candidate, Joanna L. Starrels, MD, MS, is an Assistant Professor of Medicine at Albert EinsteinCollege of Medicine. Her long-term goal is to become an independent investigator in defining and promotingevidence-based and responsible opioid prescribing strategies for primary care patients with chronic pain. Hershort-term goals are to gain expertise in: opioid misuse in pain management, advanced qualitative research,interventions to change physician behavior, and analysis of longitudinal data. Dr. Starrels has assembled amentoring team that includes national leaders in substance abuse, pain management, and health care delivery.
The United States faces an epidemic of prescription pain killer abuse and overdose. Treatment agreementsbetween physicians and their chronic pain patients who are prescribed such drugs may help to reduce abuseand overdose. This study will identify physicians' barriers to using treatment agreements and develop a modelintervention to promote and study the use of treatment agreements in primary care settings.
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