A Collaborative Care Intervention to Improve Opioid Prescribing Among Providers Caring for Persons with HIV: Impact on Satisfaction, Confidence, and Trust

• Type of Material: Article
• Authors: Jonathan Arthur Colasanti, Emory University; Carlos del Rio, Emory University; Debbie M Cheng, Boston University; Jane M Liebschutz, University of Pittsburgh; Marlene C Lira, Boston University; Judith I Tsui, University of Washington; Alexander Y Walley, Boston University; Leah S Forman, Boston University; Christin Root, Emory University; Christopher W Shanahan, Boston University; Carly L Bridden, Boston University; Catherine Abrams, Emory University; Catherine Harris, Emory University; Kishna Outlaw, Emory University; Wendy Armstrong, Emory University; Jeffrey H Samet, Boston University
• Language: English
• Date: 2000-12-31
• Publisher: Georg Thieme Verlag
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2000 The Author(s). Rights managed by Thieme.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2000-11129
• Title of Journal or Parent Work: Planta Medica
• Volume: 231
• Grant/Funding Information: This work was supported by the National Institutes of Health through (grant number R01DA037768 from the National Institute on Drug Abuse); the Emory Center for AIDS Research (grant number P30AI050409 from the National Institute of Allergy and Infectious Diseases); and the Boston/Providence Center for AIDS Research (grant number P30AI042853 from the National Institute of Allergy and Infectious Diseases).
• Keywords: Opioids; chronic opioid therapy; Pain management; HIV
• Research Categories: Chemistry, General; Chemistry, Organic

Abstract

Background: HIV clinicians report low confidence and satisfaction prescribing chronic opioid therapy (COT). We hypothesized that the Targeting Effective Analgesia in Clinics for HIV (TEACH) intervention [a system-level improvement to increase guideline concordant care for COT] would improve satisfaction, confidence, and trust among PWH and their clinicians. Methods: We conducted a two-arm, unblinded cluster randomized controlled trial (RCT) to assess the TEACH intervention. Clinicians were randomized in a 1:1 ratio to receive either the TEACH intervention (an IT-enabled nurse care manager, opioid education, academic detailing, and access to addiction specialists) or usual care. Outcomes were the following: clinician satisfaction (primary); confidence prescribing COT; patient satisfaction with COT; and trust in clinician. Intention-to-treat analyses were conducted using linear and logistic regression models. Results: Clinicians (n=41) were randomized and their 114 patients assessed. At 12 months, the adjusted mean difference in satisfaction with COT was 1.11 points for intervention vs control clinicians (Scale 1–10; 95% confidence interval [CI]: −0.04–2.26, p=0.06). The adjusted mean confidence with prescribing COT was 1.01 points higher among intervention clinicians (Scale 1–10; 95% CI: 0.05–1.96, p=0.04). There were no significant differences in patient satisfaction with COT (adjusted odds ratio (AOR) 1.17, 95% CI: 0.50–2.76, p=0.72) or trust in provider (AOR 1.63, 95% CI: 0.65–4.09, p=0.30). Conclusions: TEACH did not significantly affect prescriber satisfaction, patient satisfaction with pain management or patient trust; however, it did improve prescriber confidence. TEACH is a promising strategy to improve provider prescribing of COT for PWH without adverse patient satisfaction or trust in provider.