■开发和评估一种新型阿片类药物安全诊所（OSC）计划，以增强对处方慢性阿片类药物治疗（COT）患者评估和监测指南的依从性。
■OSC是在城市联邦合格的健康中心开发的，旨在为COT提供指导一致的护理，标准化工作流，并有效利用诊所工作人员。我们使用匹配的队列研究评估了OSC。2014年7月1日至2016年3月31日期间，共有539名患者参加了该诊所。其中,在OSC访视之日，472名临床参与者与472名非参与者按性别和年龄进行匹配。OSC通过标准化疼痛评估的完成率进行评估，尿液毒理学,和纳洛酮配药。我们进行了逻辑回归比较OSC参与者与非OSC参与者。
■共有539名患者参加了OSC访问，约占慢性阿片类药物登记患者的53%。OSC参与者比非参与者更有可能完成疼痛评估(调整后的优势比[aOR]，169.8；95%CI，98.3-293.5），完成了尿液毒理学(aOR，46.1；95%CI，30.4-69.9），或分配了纳洛酮(aOR，2.8；95%CI，1.9-4.3）超过12个月的随访。
■OSC模式提高了初级保健对指南一致COT的依从性。未来的研究需要评估这些干预措施对疼痛的影响，生活质量,和阿片类镇痛药的不良事件。
OBJECTIVE: To develop and evaluate a novel Opioid Safety Clinic (OSC) initiative to enhance adherence to
guidelines on the assessment and monitoring of patients prescribed chronic opioid therapy (COT).
METHODS: The OSC was developed at an urban Federally Qualified Health Center to provide
guideline-concordant care for COT, standardize workflows, and efficiently use clinic staff. We evaluated the OSC using a matched cohort study. Five hundred thirty-nine patients participated in the clinic between July 1, 2014, and March 31, 2016. Of these, 472 clinic participants were matched to 472 nonparticipants by sex and age on the date of the OSC visit. The OSC was evaluated by its completion rates of standardized pain assessments, urine toxicology, and naloxone dispensings. We conducted logistic regression comparing OSC participants to OSC nonparticipants.
RESULTS: A total of 539 patients attended an OSC visit, representing approximately 53% of patients in the chronic opioid registry. The OSC participants were more likely than nonparticipants to have completed a pain assessment (adjusted odds ratio [aOR], 169.8; 95% CI, 98.3-293.5), completed a urine toxicology (aOR, 46.1; 95% CI, 30.4-69.9), or had naloxone dispensed (aOR, 2.8; 95% CI, 1.9-4.3) over 12 months of follow-up.
CONCLUSIONS: The OSC model improved adherence to
guideline-concordant COT in primary care. Future research is needed to assess the impact of these interventions on pain, quality of life, and adverse events from opioid analgesics.
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