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Collaborative Care Improves HIV Provider
Confidence in Managing Chronic Opioid Therapy
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10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City
"HIV providers' practice often diverge from opioid prescribing guidelines"
"An HIV primary care program for chronic opioid therapy guideline concordance
improved prescriber confidence,
without negatively impacting prescriber satisfaction, patient satisfaction with pain management or patient trust in provider."
Mark Mascolini
An intervention to promote following care guidelines for people receiving chronic opioid therapy improved HIV provider confidence in managing therapy compared with standard care in a randomized trial at two US safety-net HIV clinics [1]. Adopting the consensus guidelines did not compromise prescriber or patient satisfaction, or patient trust in the provider, when compared with standard care.
TEACH (Targeting Effective Analgesia in Clinics for HIV) is a randomized controlled trial testing the effectiveness of a collaborative care intervention to improve quality of care in prescribing chronic opioid therapy for people with HIV [2]. Ultimately, TEACH aims to reduce pain and misuse of prescription opioids in HIV-positive people. This two-arm cluster-randomized trial compared the TEACH collaborative care intervention with standard practice among chronic opioid therapy prescribers at two safety-net hospital-based HIV clinics in the United States. The TEACH intervention relied on a nurse case manager with an electronic registry to manage patients, education and academic detailing, and access to addiction specialists. The control intervention was an educational brochure.
The trial's primary outcome was prescriber satisfaction in managing chronic opioid therapy at 12 months measured on a 1-to-10 scale. There were three secondary outcomes: prescriber confidence in managing chronic opioid therapy at 12 months (1-to-10 scale); patient satisfaction with pain management at 12 months (top quartile versus lower three quartiles); and patient trust in provider at 12 months (top quartile versus lower three quartiles). Intention-to-treat analysis of results used linear and logistic regression models. Covariates were study site and number of patients on chronic opioid therapy per provider.
The trial involved 21 providers in the intervention arm and 20 in the control arm. Provider age averaged 45 and 46 years in the intervention and control groups, 57% and 70% were female, and 57% and 70% were white. Providers in the intervention and control groups averaged 4.1 and 5.0 patients on chronic opioid therapy.
The intervention group had 87 patients and the control group had 100. Age in the two groups averaged 54.4 and 53.5 years, two thirds in each group were black, and 8% in each group were Hispanic. Most participants in the intervention and control groups (64% and 70%) completed high school, while 25% and 19% ever injected drugs.
Compared with standard practice, provider confidence in managing chronic opioid therapy was significantly higher with the TEACH intervention (adjusted mean difference 1.01, 95% confidence interval [CI] 0.05 to 1.96, P = 0.039). The intervention did not compromise provider satisfaction in managing chronic opioid therapy (adjusted mean difference 1.11, 95% CI -0.04 to 2.26, P = 0.059), patient satisfaction (adjusted odds ratio 1.17, 95% CI 0.50 to 2.76, P = 0.72) or patient trust in the provider (adjusted odds ratio 1.63, 95% CI 0.65 to 4.09, P = 0.30).
The researchers proposed that "the TEACH intervention is a promising strategy to improve adherence to guidelines for chronic opioid therapy" in people with HIV.
References
1. Del Rio C, Tsui J, Cheng D, et al. Targeting Effective Analgesia in Clinics for HIV (TEACH): A randomized controlled trial (RCT) to improve satisfaction, confidence, and trust around chronic opioid therapy in HIV care. 10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City. Abstract MOPDB0104.
2. ClinicalTrials.gov. Targeting Effective Analgesia in Clinics for HIV-Intervention (TEACH). ClinicalTrial.gov identifier NCT02564341. https://clinicaltrials.gov/ct2/show/NCT02564341
poster
Targeting Effective Analgesia in Clinics for HIV (TEACH): a Randomized Controlled Trial (RCT) to Improve Satisfaction, Confidence, and Trust around Chronic Opioid Therapy in HIV Care
C del Rio1, J Tsui2, D Cheng3, JA Colasanti1, J Liebschutz4, M Lira5, L Forman3, CW Shanahan6, C Root7, C Bridden5, K Outlaw7, C Abrams7, J Carroll8, AY Walley6,JH Samet6
1Emory School of Public Health, 2University Washington, 3Boston University School of Public Health, 4University of Pittsburgh, 5Boston Medical Center,
6Boston University School of Medicine, 7Emory University School of Public Health, 8Emory University
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