July 24, 2019 | MICHAELA FLEMING
People living with HIV who experience chronic pain are often treated with long-term opioid therapy. With such a high prevalence of chronic pain among people living with HIV (PLWH), providers sometimes deviate from opioid prescribing guidelines. It is largely unknown whether system improvements to increase care that is consistent with guidelines have an impact on elements of the patient-physician relationship, including satisfaction, trust, and confidence.
With this in mind, a team of researchers launched the Effective Analgesia in HIV Clinics (TEACH) study, a 2-arm, randomized, controlled clinical trial that assessed whether a collaborative care intervention could improve chronic opioid treatment prescribing practices and satisfaction with care.
The findings were presented by Carlos del Rio, MD, a member of the Contagion® Editorial Advisory Board, at the 10th IAS Conference on HIV Science (NIC 2019).
For the study, researchers recruited chronic opioid therapy providers and patients from two HIV clinics. Providers were randomly assigned 1:1 to receive either the TEACH intervention or the control, which consisted of a handout on safe opioid prescribing. Under the TEACH intervention, providers received a trained IT-enabled nurse care manager, opioid education and academic details, and access to addiction specialists.
The primary outcome of the study was provider satisfaction at 12 months. Secondary outcomes included provider confidence in prescribing chronic opioid therapy; patient satisfaction with chronic opioid therapy; and patient confidence in the provider.
The study recruited a total of 41 providers: 34% male, 63% white, 78% MDs, with a mean age of 46 years. A total of 187 patients were enrolled: 72% male, 28% white, with a mean age of 54 years. Furthermore, 91% of the patients had an undetectable HIV viral load and 15% had a history of injection drug use.
According to the results, at 12 months, adjusted mean satisfaction with chronic opioid treatment was 1.11 points higher among providers in the intervention group (Scale 1-10; 95% confidence interval [CI]: -0.04-2.26, p = 0.06). The researchers wrote that “adjusted mean confidence with prescribing [chronic opioid therapy] was 1.01 points higher among intervention providers (Scale 1-10; 95% CI: 0.05-1.96, p = 0.04).”
Furthermore, it is reported that no significant differences were detected in patient satisfaction with chronic opioid treatment (adjusted odds ratio (AOR) 1.17, 95% CI: 0.50-2.76, p = 0.72) or provider trust (AOR 1.63, 95% CI: 0.65-4.09, p = 0.30).
Based on these data, it can be concluded that providers who received the intervention materials had greater satisfaction and confidence in prescribing chronic opioid therapy than their colleagues who received the control materials. Furthermore, the intervention did not negatively impact patient satisfaction or trust in their providers. Therefore, the researchers conclude that the TEACH intervention is a promising way to improve chronic opioid prescribing practices for patients with low birth weight (LBWH).
On Monday, July 22, 2019, the poster, “How to Teach Effective Analgesia in HIV Clinics (TEACH): A Randomized Controlled Trial (RCT) to Improve Satisfaction, Confidence, and Trust Around Chronic Opioid Therapy in HIV Care,” was presented at NIC 2019 in Mexico City, Mexico.
From: https://www.contagionlive.com/news/teach-study-interventions-improve-prescriber-confidence-in-chronic-opioid-therapy-in-plwh