Interventions to Influence Opioid Prescribing Practices for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis

被引:9
作者
Asamoah-Boaheng, Michael [1 ]
Badejo, Oluwatosin A. [1 ]
Bell, Louise, V [2 ]
Buckley, Norman [3 ]
Busse, Jason W. [3 ,4 ,5 ,6 ]
Campbell, Tavis S. [7 ]
Corace, Kim [8 ,9 ,10 ]
Cooper, Lynn [11 ]
Flusk, David [12 ]
Garcia, David A. [1 ]
Hossain, Mohammad A. [1 ]
Iorio, Alfonso [4 ]
Lavoie, Kim L. [13 ,14 ]
Poulin, Patricia A. [15 ,16 ,17 ,18 ]
Skidmore, Becky
Rash, Joshua A. [2 ]
机构
[1] Mem Univ Newfoundland, Clin Epidemiol, St John, NF, Canada
[2] Memo Rial Univ Newfoundland, Dept Psychol, 230 Elizabeth Ave, St John, NF A1B 3X9, Canada
[3] McMaster Univ, Dept Anesthesia, Hamilton, ON, Canada
[4] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
[5] McMaster Univ, Michael G DeGroote Inst Pain Res & Care, Hamilton, ON, Canada
[6] McMaster Univ, Michael G DeGroote Ctr Med Cannabis Res, Hamilton, ON, Canada
[7] Univ Calgary, Dept Psychol, Calgary, AB, Canada
[8] Royal Ottawa Mental Hlth Ctr, Ottawa, ON, Canada
[9] Univ Ottawa, Dept Psychiat, Ottawa, ON, Canada
[10] Univ Ottawa, Inst Mental Hlth Res, Ottawa, ON, Canada
[11] Canadian Injured Workers Alliance, Thunder Bay, ON, Canada
[12] Mem Univ Newfoundland, Dept Anesthesia, St John, NF, Canada
[13] Univ Quebec Montreal, Dept Psychol, Montreal, PQ, Canada
[14] Hop Sacre Coeur Montreal, Ctr Integree Univ Sante & Serv Sociaux Nord Ile, Montreal Behav Med Ctr MBMC, Montreal, PQ, Canada
[15] Ottawa Hosp, Res Inst, Ottawa, ON, Canada
[16] Ottawa Hosp, Dept Psychol, Ottawa, ON, Canada
[17] Ottawa Hosp, Pain Clin, Ottawa, ON, Canada
[18] Univ Ottawa, Dept Anesthesiol & Pain Med, Ottawa, ON, Canada
基金
加拿大健康研究院;
关键词
PRIMARY-CARE; RANDOMIZED-TRIALS; CDC GUIDELINE; UNITED-STATES; MANAGEMENT; THERAPY; PRESCRIPTION; ADHERENCE; MISUSE; STRATEGIES;
D O I
10.1016/j.amepre.2020.07.012
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Context: This study is a systematic review of interventions to improve adherence to guideline recommendations for prescribing opioids for chronic noncancer pain. Evidence acquisition: Investigators searched CINAHL, Em base, MEDLINE, PsycINFO, the Cochrane Library, and Joanna Briggs Institute Evid Based Pract database from inception until June 3, 2019. Interventional studies to improve adherence to recommendations made by opioid guidelines for chronic noncancer pain in North America were eligible if outcomes included adherence to guideline recommendations or change in quantity of opioids prescribed. Data were extracted independently and in duplicate. Quantitative synthesis was performed using random effects meta-analysis. Confidence in evidence was determined using the Grades of Recommendation, Assessment, Development, and Evaluation. Evidence synthesis: A total of 20 studies (8 controlled and 12 prospective cohort) involving 1,491 providers and 72 clinics met inclusion. Interventions included education, audit and feedback, interprofessional support, shared decision making, and multifaceted strategies. Multifaceted interventions improved the use of urine drug testing (n=2, or =2.31, 95% CI=1.53, 3.49, z=3.98, p<0.01; high-certainty evidence), treatment agreements (n=2, or =1.96, 95% CI=1.47, 2.61, z=4.56, p<0.01; moderate-certainty evidence), and mental health screening (n=2, 2.57-fold, 95% CI=1.56, 4.24, z=2.32, p=0.02; low-certainty evidence) when prescribing opioids for chronic noncancer pain. Very low-certainty evidence suggests that several interventions improved the use of treatment agreements, urine drug testing, and prescription drug monitoring programs. Conclusions: Mostly very low-certainty evidence supports a number of interventions for improving adherence to risk management strategies when prescribing opioids for chronic noncancer pain; however, the effect on patient important outcomes (e.g., overdose, addiction, death) is uncertain. (C) 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:E15 / E26
页数:12
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