COVID-19-related adaptations to the implementation and evaluation of a clinic-based intervention designed to improve opioid safety

Abstract

The United States faces an opioid crisis with an unprecedented and increasing death rate from opioid overdose. Successfully reducing the rates of opioid use disorder (OUD) and overdose will require the engagement of frontline clinicians to prescribe opioids more safely and to build their capacity to treat patients with OUD using evidence-based approaches. The COVID-19 pandemic has created significant challenges for patients, clinicians and health systems and has been associated with increasing risks of overdoses and deaths. Herein, we review a multidisciplinary project designed to implement and evaluate clinic-based interventions in Oregon, USA, to improve pain management, opioid prescribing and treatment of OUD. The intervention, called Improving PaIn aNd OPiOId MaNagemenT in Primary Care (PINPOINT), combines practice facilitation, academic detailing and education through the Oregon ECHO Network. Implementation of PINPOINT has occurred across the Oregon Rural Practice-based Research Network and has involved 49 clinic sites to date. To evaluate the impact of the intervention, the research team created the Provider Results of Opioid Management and Prescribing Training (PROMPT), a dataset that links information from the state prescription drug monitoring program, all-payer claims database, emergency medical services, vital records and substance use disorder treatment system. The PROMPT dataset will allow evaluation of the impact of the intervention at both the clinician and clinic levels. Due to the constraints of the COVID-19 pandemic, elements of both implementation and evaluation required significant adaptations to continue to meet the original project goals.

Impact of COVID-19 pandemic on chronic pain and opioid use in marginalized populations: A scoping review

“…In addition to reductions in in-person activity, some clinics endured major staffing cuts or lacked appropriately trained staff (i.e., nurse practitioners, general practitioners) in their new telemedicine treatment centers. Reduced capacity ultimately limited the types of telemedicine services offered ( 78 , 93 ).…”

“…Given that pain management, especially education on the assessment and treatment of OUD, is often underrepresented in clinical educational curricula, adaptations made during the pandemic also contributed to increased burden of care for clinicians. Compounding fears of COVID-19 infection, increased stress, symptoms of depression and anxiety, sleep disturbances, and increased burnout rates among clinicians, nurses, and frontline workers were cited globally, all of which could potentially impair clinical judgment ( 3 , 85 , 93 ). While clinicians ultimately sought to balance the risk of harm with minimizing pain in vulnerable pain populations, reallocation of healthcare resources and altered work natures (i.e., shifting to telehealth) were cited as barriers to efficacious pain treatments ( 80 , 93 ).…”

The evolution of the overdose epidemic and CDC’s research response: a commentary

“…Other work in this special issue highlights the importance of being nimble in addressing a national epidemic in the wake of a global pandemic and how implementation and evaluation efforts were modified during the COVID-19 pandemic. 12 …”

Combating the opioid epidemic in the United States

“…COVID-19 has presented new challenges to the delivery of academic detailing programmes, with providers and health systems strained by COVID-19 and the necessary transition of educational outreach from in-person to virtual delivery. Adaptations necessitated by constraints imposed by the pandemic are described in a paper by Morgan et al, 9 which focuses on a systems-level approach to practice-based interventions intended to enhance opioid safety through the development of a linked data resource that allows for evaluation of opioid-related outcomes. McQuade et al 10 demonstrate the value of adopting educational outreach with patients and their families, using an intervention that focused on the elderly and their families, who reported improvement in the knowledge of opioids and naloxone use.…”