背景:阿片类药物的过度处方导致阿片类药物的滥用增加,导致更高的用药过量率。工作场所在个人滥用处方阿片类药物的意图中起着至关重要的作用,受伤的工人被处方阿片类药物,是全国平均水平的3倍。例如,医护人员有受伤的危险,阿片类药物配药,和转移。在可能导致阿片类药物滥用风险的背景下进行干预,同时针对个人社会心理因素,可能是对政策和处方水平干预的有益补充。
目的:这项初步研究使用多相优化策略设计的准备阶段,评估了为医护人员量身定制的移动友好型阿片类药物滥用干预原型的效果。
方法:共有33名卫生保健从业人员参与了试点干预,其中包括10个简短的基于网络的经验教训,旨在影响滥用阿片类药物的心理社会措施。课程主题包括:成瘾信念,控制成瘾,疾病控制和预防中心指南和建议,关于病人-提供者关系和沟通的信念,与提供者通信时的控制,关于自我监测疼痛和副作用的信念,控制自我监测疼痛和副作用,转移和处置信念,分流和处置控制,一个总结的教训。使用仅治疗的设计,收集了前测和后测调查。一般线性重复测量ANOVA用于评估从前测到后测的平均差异。描述性统计用于评估参与者对干预的反馈。
结果:完成干预后,随着阿片类药物知识的增加,参与者表现出显著的平均变化(+0.459;P<.001),对阿片类药物的不利态度(-1.081;P=.001),关于与提供者沟通的更多积极信念(+0.205;P=0.01),更多关于疼痛管理控制的积极信念(+0.969;P<.001),以及避免使用阿片类药物的意愿增加(+0.212;P=0.03)。在完成该计划的33名从业者中,大多数人对所提供的信息感到乐观,几乎70%(23/33)同意或强烈同意该行业的其他工人应该完成这样的程序。
结论:虽然已通过公共卫生政策和处方举措尝试解决阿片类药物危机,阿片类药物滥用继续上升。某些行业使工人面临更大的伤害和阿片类药物分配风险,对这些行业的工人进行特别重要的干预。这项试点研究的结果显示出对知识的积极影响,态度,以及与提供者沟通和疼痛管理控制的信念,以及避免滥用阿片类药物的意图。然而,辍学率和小样本量是严重的限制,结果缺乏普遍性。结果将用于通知程序修订和未来的优化试验,旨在为未来的干预开发和评估员工的移动友好型电子健康干预措施提供见解。
BACKGROUND: Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual\'s intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels.
OBJECTIVE: This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design.
METHODS: A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention.
RESULTS: After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (-1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this.
CONCLUSIONS: While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees.