Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices

Abstract

Background: The Six Building Blocks for improving opioid management (6BBs) is a program for improving the management of patients in primary care practices who are on long-term opioid therapy for chronic pain. The 6BBs include building leadership and consensus; aligning policies, patient agreements, and workflows; tracking and monitoring patient care; conducting planned, patient-centered visits; tailoring care for complex patients; and measuring success. The Agency for Healthcare Research and Quality funded the development of a 6BBs implementation guide: a step-by-step approach for independently implementing the 6BBs in a practice. This mixedmethod study seeks to assess practices' use of the implementation guide to implement the 6BBs and the effectiveness of 6BBs implementation on opioid management processes of care among practices using the implementation guide. Methods: Data collection is guided by the Consolidated Framework for Implementation Research, Proctor's taxonomy of implementation outcomes, and the Centers for Disease Control and Prevention's Guideline for Prescribing Opioids for Chronic Pain. A diverse group of health care organizations with primary care clinics across the USA will participate in the study over 15 months. Qualitative data collection will include semi-structured interviews with stakeholders at each organization at two time points, notes from routine check-in calls, and document review. These data will be used to understand practices' motivation for participation, history with opioid management efforts, barriers and facilitators to implementation, and implementation progress. Quantitative data collection will consist of a provider and staff survey, an implementation milestones assessment, and quarterly opioid prescribing quality measures. These data will supplement our understanding of implementation progress and will allow us to assess changes over time in providers' opioid prescribing practices, prescribing self-efficacy, challenges to providing guideline-driven care, and practices' opioid prescribing quality measures. Qualitative data will be coded and analyzed for emergent themes. Quantitative data will be analyzed using descriptive statistics and clustered multivariate regression. Discussion: This study contributes to the knowledge of the implementation and effectiveness of a team-based approach to opioid management in primary care practices. Information gleaned from this study can be used to inform efforts to curtail opioid prescribing and assist primary care practices considering implementing the 6BBs.

Using Deprescribing Practices and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions Criteria to Reduce Harm and Preventable Adverse Drug Events in Older Adults

“…Regardless of the type of intervention, an essential component to ensure that any evidence-based approaches or criteria effectively change prescribing practices and that key outcomes can be the implementation approaches or strategies that are used. 39 , 40 Although this review included one study that was an implementation-effectiveness design study, there is vast opportunity to expand the field’s understanding of how to effectively implement these interventions. 41 Further systematic reviews and meta-analyses, where feasible, for other patient safety practices addressing preventable ADEs in older adults would also be valuable to the field.…”

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

“…Practice facilitation – ORPRN practice facilitators support clinics through evidence-based practice change to improve pain management and opioid prescribing (such as The Six Building Blocks of Opioid Prescribing 23 , 24 framework and Oregon ECHO network educational opportunities). 20…”