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Colasanti JA, Del Rio C, Cheng DM, Liebschutz JM, Lira MC, Tsui JI, Walley AY, Forman LS, Root C, Shanahan CW, Bridden CL, Harris C, Outlaw K, Armstrong WS, Samet JH. A collaborative care intervention to improve opioid prescribing among providers caring for persons with HIV: Impact on satisfaction, confidence, and trust. Drug Alcohol Depend 2022; 231:109250. [PMID: 34998255 PMCID: PMC10763596 DOI: 10.1016/j.drugalcdep.2021.109250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND HIV clinicians report low confidence and satisfaction prescribing chronic opioid therapy (COT). We hypothesized that the Targeting Effective Analgesia in Clinics for HIV (TEACH) intervention [a system-level improvement to increase guideline concordant care for COT] would improve satisfaction, confidence, and trust among PWH and their clinicians. METHODS We conducted a two-arm, unblinded cluster randomized controlled trial (RCT) to assess the TEACH intervention. Clinicians were randomized in a 1:1 ratio to receive either the TEACH intervention (an IT-enabled nurse care manager, opioid education, academic detailing, and access to addiction specialists) or usual care. Outcomes were the following: clinician satisfaction (primary); confidence prescribing COT; patient satisfaction with COT; and trust in clinician. Intention-to-treat analyses were conducted using linear and logistic regression models. RESULTS Clinicians (n = 41) were randomized and their 114 patients assessed. At 12 months, the adjusted mean difference in satisfaction with COT was 1.11 points for intervention vs control clinicians (Scale 1-10; 95% confidence interval [CI]: -0.04 to 2.26, p = 0.06). The adjusted mean confidence with prescribing COT was 1.01 points higher among intervention clinicians (Scale 1-10; 95% CI: 0.05-1.96, p = 0.04). There were no significant differences in patient satisfaction with COT (adjusted odds ratio (AOR) 1.17, 95% CI: 0.50-2.76, p = 0.72) or trust in provider (AOR 1.63, 95% CI: 0.65-4.09, p = 0.30). CONCLUSIONS TEACH did not significantly affect prescriber satisfaction, patient satisfaction with pain management or patient trust; however, it did improve prescriber confidence. TEACH is a promising strategy to improve provider prescribing of COT for PWH without adverse patient satisfaction or trust in provider.
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Affiliation(s)
- Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States; Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States; Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave., 3rd Floor, Boston, MA 02118, United States.
| | - Jane M Liebschutz
- Department of Medicine, University of Pittsburgh School of Medicine, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Marlene C Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, United States.
| | - Judith I Tsui
- Department of Medicine, University of Washington School of Medicine, RR-512, Health Sciences Building, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, United States.
| | - Alexander Y Walley
- Department of Medicine, University of Pittsburgh School of Medicine, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, United States.
| | - Christin Root
- Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Christopher W Shanahan
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, United States.
| | - Carly L Bridden
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, United States.
| | - Catherine Harris
- Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Kishna Outlaw
- Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States.
| | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, United States; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., 4th Floor, Boston MA 02118, United States.
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Samet JH, Tsui JI, Cheng DM, Liebschutz JM, Lira MC, Walley AY, Colasanti JA, Forman LS, Root C, Shanahan CW, Sullivan MM, Bridden CL, Abrams C, Harris C, Outlaw K, Armstrong WS, del Rio C. Improving the Delivery of Chronic Opioid Therapy Among People Living With Human Immunodeficiency Virus: A Cluster Randomized Clinical Trial. Clin Infect Dis 2021; 73:e2052-e2058. [PMID: 32697847 PMCID: PMC8492355 DOI: 10.1093/cid/ciaa1025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/16/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic pain is prevalent among people living with human immunodeficiency virus (PLWH); managing pain with chronic opioid therapy (COT) is common. Human immunodeficiency virus (HIV) providers often diverge from prescribing guidelines. METHODS This 2-arm, unblinded, cluster-randomized clinical trial assessed whether the Targeting Effective Analgesia in Clinics for HIV (TEACH) intervention improves guideline-concordant care compared to usual care for PLWH on COT. The trial was implemented from 2015 to 2018 with 12-month follow-up at safety-net hospital-based HIV clinics in Boston and Atlanta. We enrolled 41 providers and their 187 patients on COT. Prescribers were randomized 1:1 to either a 12-month intervention consisting of a nurse care manager with an interactive electronic registry, opioid education, academic detailing, and access to addiction specialists or a control condition consisting of usual care. Two primary outcomes were assessed through electronic medical records: ≥2 urine drug tests and any early COT refills by 12 months. Other outcomes included possible adverse consequences. RESULTS At 12 months, the TEACH intervention arm had higher odds of ≥2 urine drug tests than the usual care arm (71% vs 20%; adjusted odds ratio [AOR], 13.38 [95% confidence interval {CI}, 5.85-30.60]; P < .0001). We did not detect a statistically significant difference in early refills (22% vs 30%; AOR, 0.55 [95% CI, .26-1.15]; P = .11), pain severity (6.30 vs 5.76; adjusted mean difference, 0.10 [95% CI, -1.56 to 1.75]; P = .91), or HIV viral load suppression (86.9% vs 82.1%; AOR, 1.21 [95% CI, .47-3.09]; P = .69). CONCLUSIONS TEACH is a promising intervention to improve adherence to COT guidelines without evident adverse consequences.
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Affiliation(s)
- Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Clinical Addiction Research and Education Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Debbie M Cheng
- Clinical Addiction Research and Education Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jane M Liebschutz
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marlene C Lira
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Clinical Addiction Research and Education Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christin Root
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Christopher W Shanahan
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Clinical Addiction Research and Education Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Margaret M Sullivan
- Clinical Addiction Research and Education Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carly L Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Catherine Abrams
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Catherine Harris
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Kishna Outlaw
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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Tsui JI, Walley AY, Cheng DM, Lira MC, Liebschutz JM, Forman LS, Sullivan MM, Colasanti J, Root C, O'Connor K, Shanahan CW, Bridden CL, Del Rio C, Samet JH. Provider opioid prescribing practices and the belief that opioids keep people living with HIV engaged in care: a cross-sectional study. AIDS Care 2019; 31:1140-1144. [PMID: 30632790 DOI: 10.1080/09540121.2019.1566591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We describe HIV providers' opioid prescribing practices and assess whether belief that chronic opioid therapy (COT) keeps people living with HIV (PLWH) engaged in care is associated with differences in these practices among providers from two HIV clinics. We conducted logistic regression to evaluate the association between the belief that COT keeps PLWH engaged in care and at least one component of guideline-recommended care (i.e., urine drug tests, treatment agreements, and/or prescription monitoring program use). The sample included 41 providers with a median age of 42 years, 63% female, 37% non-white. Routine adherence to guideline-recommended practices was: 34% urine drug tests, 27% treatment agreements, and 17% prescription monitoring program. Over half [54%] agreed that COT keeps PLWH engaged in care. There was no significant association between belief that COT keeps PLWH engaged in care and routinely providing any recommended COT care component (aOR 2.38; 95% CI 0.65-8.73). Most HIV providers do not routinely follow guidelines for opioid prescribing. We observed a positive association between belief that COT keeps PLWH engaged in care and following any guideline-recommended prescribing practices, although the result was not statistically significant. Interventions are needed to improve guideline-concordant care for COT by HIV providers.
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Affiliation(s)
- Judith I Tsui
- a Section of General Internal Medicine, Department of Medicine , University of Washington , Seattle , WA , USA
| | - Alexander Y Walley
- b Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine , Boston University School of Medicine , Boston , MA , USA.,c Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine and Grayken Center for Addiction , Boston Medical Center , Boston , MA , USA
| | - Debbie M Cheng
- d Department of Biostatistics , Boston University School of Public Health , Boston , MA , USA
| | - Marlene C Lira
- c Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine and Grayken Center for Addiction , Boston Medical Center , Boston , MA , USA
| | - Jane M Liebschutz
- e Section of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Leah S Forman
- f Biostatistics and Epidemiology Data Analytics Center , Boston University School of Public Health , Boston , MA , USA
| | - Margaret M Sullivan
- g Section of Infectious Diseases, Department of Medicine , Boston University School of Medicine , Boston , MA , USA
| | - Jonathan Colasanti
- h Divison of Infectious Diseases, Department of Medicine , Emory University School of Medicine , Atlanta , GA , USA.,i Hubert Department of Global Health , Rollins School of Public Health of Emory University , Atlanta , GA , USA
| | - Christin Root
- i Hubert Department of Global Health , Rollins School of Public Health of Emory University , Atlanta , GA , USA
| | - Kristen O'Connor
- c Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine and Grayken Center for Addiction , Boston Medical Center , Boston , MA , USA
| | - Christopher W Shanahan
- c Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine and Grayken Center for Addiction , Boston Medical Center , Boston , MA , USA
| | - Carly L Bridden
- c Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine and Grayken Center for Addiction , Boston Medical Center , Boston , MA , USA
| | - Carlos Del Rio
- h Divison of Infectious Diseases, Department of Medicine , Emory University School of Medicine , Atlanta , GA , USA.,i Hubert Department of Global Health , Rollins School of Public Health of Emory University , Atlanta , GA , USA
| | - Jeffrey H Samet
- b Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine , Boston University School of Medicine , Boston , MA , USA.,c Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine and Grayken Center for Addiction , Boston Medical Center , Boston , MA , USA.,j Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA
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