Stories to Promote Information Using Narrative (SPIN) Trial

Transcription

1 Stories to Promote Information Using Narrative (SPIN) Trial A novel approach to promote the uptake and use of a guideline on opioid prescriptions in the Emergency Department (ED) Anand Gopal Mentor: Zachary Meisel, MD, MPH, MSc SUMR Research Symposium August 17, 2012

2 Overview Opioid Prescription Trends Significance of Opioids in the ED New Clinical Guideline Narrative Theory Study Design and Methods Future Directions Lessons Learned

3 An Epidemic by the Numbers EACH YEAR: 15,000 people die from opioid overdoses in the US 1 1 in 20 persons in the US aged 12 and older report using opioid painkillers non-medically 2 Nonmedical use of opioid painkillers costs more than $72.5 billion annually in direct health care costs 1 1 CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers United States, MMWR 2011; 60: 1-6; 2 Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: volume 1: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; Available from URL:

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6 On Opioid Prescriptions in the ED Estimated 42% of ED visits are pain-related 1 In 2009, EM ranked 3rd among all specialties for opioid prescriptions written for adults between the ages of 20 to 39 2 ED patients recognized to be at high risk for opioid abuse 3 Misuse and abuse of prescription painkillers responsible for more than 475,000 ED visits in Pletcher MJ, Kertesz SG, Kohn MA, et al. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299:70-78.; 2 Volkow ND, McLellan TA, Cotto JH. Characteristics of opioid prescriptions in JAMA ;305: ; 3 Hansen GR. The drug-seeking patient in the emergency room. Emerg Med Clin North Am. 2005;23: ; 4 Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network: selected tables of national estimates of drug-related emergency department visits. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA; 2010.

7 A Chronic Dilemma in the ED According to the FDA, health care professionals are in a key position to balance the benefits of prescribing opioids to treat pain against the risk of serious adverse outcomes including addiction, unintentional overdose, and death.

8 New Clinical Policy June 2012 ACEP released its first evidencebased clinical policy on opioids: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

9 A Novel Approach to Dissemination and Uptake Narrative Any cohesive and coherent story with an identifiable beginning, middle and end that provides information about scene, characters and conflict; raises unanswered questions or unresolved conflict; and provides resolution. (Hinyard & Kreuter) Breaks down cognitive resistance to behavior change Official stories Invented stories Experiential stories Culturally common stories Hinyard LJ, Kreuter MW. Using narrative communication as a tool for health behavior change: A conceptual, theoretical, and empirical overview. Health Education & Behavior. 2007;34(5):

10 Narratives for Physicians Can stories be used to educate and inform physicians? Stories: Are mentally richer than simple summary Transfer knowledge, ideas, viewpoints Have the power to engage and involve recipient Are more likely to be remembered and reinforced Can be readily circulated and used to stimulate conversation

11 Research Question Can written narratives be used to disseminate and promote the adoption of evidence-based guidelines? Central Hypothesis EPs exposed to narratives will be more likely to read, recall, and act on guideline recommendations compared to those who are exposed to summary data alone

12 Phase I Phase II Phase III Baseline Assessment/ Narrative Development Randomized Controlled Trial Post-trial Assessment Aim: Elicit specific knowledge gaps, attitudes, and beliefs among EPs related to the content of an evidence-based guideline to inform the development of narratives Aim: Test narrative vs. summary dissemination strategies Aim: Compare the impact of narrative and summary communications on posttrial knowledge and intention-to-adopt guideline recommendations June 2012 January 2013 March 2013 May 2013 June 2013 October 2013

13 My Role this Summer IRB Protocol Ongoing Literature Search Narrative Development Pre-ACEP Conference Piloting Abstracting themes on specific knowledge, beliefs, attitudes Beginning narrative formulation

14 Phase I: Narrative Development Methods: Emergency Medicine Research-In-Progress (RIP) Seminar Informal focus/discussion group Elicit specific narratives from roughly 15 HUP EPs and medical students on opioids in ED Data on position, race, age, # of years clinical experience Transcribe and code each narrative Abstract high-level themes to inform trial narrative development

15 Looking ahead

16 Phase II: Randomized Controlled Trial Design Active ACEP members randomized to 1 of 2 arms Narrative vs. summary Stratification by state Intervention embedded within ACEP daily member e- newsletter, EM Today 30% unique open rate Outcomes Primary: Unique web-clicks to complete ACEP guideline Secondary: Unique web-clicks to PDMP enrollment page

17 New Clinical Guideline on Opioid Prescriptions

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19 Intervention Design Narrative Arm Summary Arm

20 Personal Takeaways Introduction to qualitative research Understanding of conceptualization and preliminary legwork involved in study design Exposure to Emergency Medicine

21 Thanks and Appreciation To Dr. Zachary Meisel Austin Kilaru Dr. Fran Barg Dr. Jeanmarie Perrone HUP Emergency Physicians Joanne Levy Lissy Madden LDI and SUMR