Testing implementation facilitation of a primary care-based collaborative care clinical program using a hybrid type
Amanda M Midboe1, Steve Martino2,3, Sarah L Krein4,5
1Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA. Amanda.Midboe@va.gov.
Implementation Science : IS
|November 30, 2018
Summary
Implementation facilitation effectively supports the Primary Care-Integrated Pain Support (PIPS) program, improving opioid prescribing and patient care in the Veterans Health Administration (VHA). This strategy enhances the adoption and sustainability of collaborative pain management models.
Area of Science:
- Implementation Science
- Health Services Research
- Pain Management
Background:
- The opioid overdose crisis necessitates evidence-based practices to reduce morbidity and mortality.
- Key strategies include reducing high-dose opioid therapy, avoiding opioid-benzodiazepine combinations, and promoting multi-modal pain care.
- Collaborative care models have shown effectiveness in supporting primary care providers for medication tapering.
Purpose of the Study:
- To evaluate the effectiveness of implementation facilitation for the Primary Care-Integrated Pain Support (PIPS) program within the Veterans Health Administration (VHA).
- To examine the impact of PIPS on patient-level outcomes, including transition to safer regimens and access to complementary health treatments.
- To determine the costs and budget impact associated with PIPS implementation.
Main Methods:
- A multi-site, interrupted time series, hybrid type III design study.
- Utilizes the Consolidated Framework for Implementation Research and the RE-AIM framework.
- Involves primary care clinics across three VHA health care systems, including pharmacists, allied staff, and patients on high-dose opioids or opioid-benzodiazepine regimens.
Main Results:
- Implementation facilitation is a key strategy for enhancing the uptake of collaborative care programs targeting unsafe opioid prescribing.
- The study assesses the reach, effectiveness, adoption, implementation, and maintenance of the PIPS program.
- Analysis includes patient-level clinical outcomes and economic impact.
Conclusions:
- Implementation facilitation is effective in supporting the adoption and sustainability of the PIPS collaborative care program.
- The findings offer crucial insights into improving opioid prescribing practices in primary care settings.
- This study contributes to understanding the successful integration of evidence-based pain management strategies.
Related Concept Videos
01:29Chronic Pancreatitis II: Collaborative Care
368
The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Assessment:
368
01:26Aneurysm III: Interprofessional Care
304
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
304
01:29Venous Thrombosis III: Interprofessional Care
370
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
370
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
307
A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
307
01:27Peripheral Artery Disease III: Interprofessional Care
342
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
342
01:28Chronic Kidney Disease III: Interprofessional Care
470
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
470