Effects of Implementing a Comprehensive Opioid Reduction Protocol on Overall Opioid Prescribing Among Patients with Chronic, Non-Cancer Pain in a Rural Family Medicine Clinic: A Controlled Cross-over Trial

Stack, Matthew A.; LaRouche, Vanessa; Zhang, Yezi; Warden, Daniel; Stack, C.G.; Klugiene, Egle A.

doi:10.3122/jabfm.2020.04.200060

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…This study revealed several barriers and facilitators 26 . Barriers encountered were lack of direct referral pathways, difficulties accessing pain specialist services, no licensed prescribers to initiate substitution therapy for patients with opioid use disorder, and stigma arising from staff preconceptions about patients receiving long term opioid therapy.…”

Section: Resultsmentioning

confidence: 92%

“…Of the 1354 articles initially identified, 32 were eligible for inclusion in our analysis. Only three studies reported interventions conducted in rural primary care settings, and all of these were conducted in the United States (, Figure 6.1) 24,26,28 . A summary of the barriers to long term opioid tapering that we identified as relevant to patients with CNCP in rural areas, along with reported and recommended facilitators of tapering, is shown in Box 1.…”

Section: Resultsmentioning

confidence: 99%

“…Universal precautions applied to pain management more generally are most often included in tapering regimens and described in relation to patient contracts, urine testing and assessment for opioid use disorder 34 . Multimodal approaches involve dosage adjustment in conjunction with management of mental health concerns and motivation 16,18,19,25,26,28 . PCP support described in the literature included education, telementoring, telehealth and referral pathways 17,27 .…”

Section: Resultsmentioning

confidence: 99%

“…These three studies conducted in rural contexts share a focus on multidisciplinary engagement and the need to redesign services to enable tapering 24,26,28 . They resemble studies conducted in non‐rural contexts, but with a focus on establishing or modifying elements that are lacking in rural environments.…”

Section: Resultsmentioning

confidence: 99%

“…Discrepancies were resolved by referral to another one of us (CH, AD, SH, RW or HR). Descriptive data on all included studies are available in the , Table 6.2 16-28 …”

Section: Methodsmentioning

confidence: 99%

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Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

Osborne¹,

Piper²,

Alston³

et al. 2020

Medical Journal of Australia

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Chapter 1: Retail initiatives to improve the healthiness of food environments in rural, regional and remote communities Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. Study design: Rapid review of articles published between January 2000 and May 2020. Data sources: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. Data synthesis: Twenty‐one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co‐design to generate community ownership and branding. Conclusion: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. Chapter 2: Which interventions best support the health and wellbeing needs of rural populations experiencing natural disasters? Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. Study design: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. Data sources: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. Data synthesis: Four of us read and assesse...

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Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Discrepancies were resolved by referral to another one of us (CH, AD, SH, RW or HR). Descriptive data on all included studies are available in the , Table 6.2 16-28 …”

Section: Methodsmentioning

confidence: 99%

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Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

Osborne¹,

Piper²,

Alston³

et al. 2020

Medical Journal of Australia

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Toward Safer Opioid Prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial

Cedillo

George

Deshpande

et al. 2022

Addict Sci Clin Pract

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Background The 2016 U.S. Centers for Disease Control Opioid Prescribing Guideline (CDC Guideline) is currently being revised amid concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). However, a methodology to faithfully implement the CDC guideline, measure prescriber adherence, and systematically test its effect on patient and public health outcomes is lacking. We developed and tested a CDC Guideline implementation strategy (termed TOWER), focusing on an outpatient HIV-focused primary care setting. Methods TOWER was developed in a stakeholder-engaged, multi-step iterative process within an Information, Motivation and Behavioral Skills (IMB) framework of behavior change. TOWER consists of: 1) a patient-facing opioid management app (OM-App); 2) a progress note template (OM-Note) to guide the office visit; and 3) a primary care provider (PCP) training. TOWER was evaluated in a 9-month, randomized-controlled trial of HIV-PCPs (N = 11) and their patients with HIV and CP-LTOT (N = 40). The primary outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the validated Safer Opioid Prescribing Evaluation Tool (SOPET). Qualitative data including one-on-one PCP interviews were collected. We also piloted patient-reported outcome measures (PROMs) reflective of domains identified as important by stakeholders (pain intensity and function; mood; substance use; medication use and adherence; relationship with provider; stigma and discrimination). Results PCPs randomized to TOWER were 48% more CDC Guideline adherent (p < 0.0001) with significant improvements in use of: non-pharmacologic treatments, functional treatment goals, opioid agreements, prescription drug monitoring programs (PDMPs), opioid benefit/harm assessment, and naloxone prescribing. Qualitative data demonstrated high levels of confidence in conducting these care processes among intervention providers, and that OM-Note supported these efforts while experience with OM-App was mixed. There were no intervention-associated safety concerns (defined as worsening of any of the PROMs). Conclusions CDC-guideline adherence can be promoted and measured, and is not associated with worsening of outcomes for people with HIV receiving LTOT for CP. Future work would be needed to document scalability of these results and to determine whether CDC-guideline adherence results in a positive effect on public health. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03669939. Registration date: 9/13/2018

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Interventions to improve primary healthcare in rural settings: A scoping review

Aubrey-Basler,

Bursey,

Pike

et al. 2024

PLoS ONE

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Background Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. Objective Synthesize and categorize studies that examine interventions to improve rural primary care. Eligibility criteria Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. Sources of evidence Pubmed, CINAHL, Cochrane Library, Embase. Charting methods We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. Results 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997–99 to a peak of 49 papers in 2017. Conclusions Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.

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Effects of Implementing a Comprehensive Opioid Reduction Protocol on Overall Opioid Prescribing Among Patients with Chronic, Non-Cancer Pain in a Rural Family Medicine Clinic: A Controlled Cross-over Trial

Cited by 6 publications

References 21 publications

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

Toward Safer Opioid Prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial

Interventions to improve primary healthcare in rural settings: A scoping review

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