The investigators will enroll 100 participants using a randomized control trial design to implement and evaluate an individualized opioid taper program supporting rural Primary Care Physicians (PCPs) caring for patients with moderate to severe trauma discharged on opioids. This study will link a trauma center Physician Assistant (PA) with rural PCPs to facilitate pain care and the individualized opioid taper. The investigators seek to improve patient's pain and opioid outcomes and support the PCPs who assume care for these complex patients after hospital discharge. Our long term goal is to provide a service that will help trauma patients as they go back into primary care and into pain- and opioid-free living.
This study explores the feasibility, efficacy, and potential sustainability of a collaborative pain care/opioid taper strategy for patients discharged to a rural PCP practice on opioids after hospitalization for moderate to severe traumatic injury. The randomized control study design will provide important pilot data on the efficacy of opioid taper in the context of engaged pain management care at the PCP level when the PCP is supported by expert consultation and has broad implications for patient and clinician education.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
100
PA checks in with PCP at 1,2,4,8, 12, 16, and 20 weeks post hospital discharge by secure e-mail, fax or phone to provide opioid taper and pain management guidance until patient has tapered off opioids or returned to pre-trauma doses. PCP may contact PA whenever needed. If PCP requests assistance or reports deviation from the planned opioid taper, PA will provide individualized consultations, which may include a revised taper plan and/or adjunctive therapy recommendations. If there is continued deviation from the planned taper, the PA will facilitate a UW TelePain multidisciplinary telemedicine consultation. The collaborative pain care and opioid taper intervention ends at 20 weeks.
Harborview Medical Center
Seattle, Washington, United States
RECRUITINGPrimary pain outcome: Pain, Enjoyment, General Activity (PEG)
Patient reported 0-10 pain severity, enjoyment of life interference, general activity interference total score
Time frame: 24 weeks
Primary opioid outcome: percent of patients at or below their pre-trauma opioid daily dose
Percent of patients at or below pre-trauma opioid dose
Time frame: 24 weeks
PROMIS-29 health status
Self-reported health status: physical function, anxiety, depression, fatigue, sleep, social. role satisfaction, pain interference, pain intensity Score range 29-150. HIgher scores better on positively worded items: physical function, social role satisfaction. Higher scores worse on negatively worded items: anxiety, depression, fatigue, sleep, pain interference, pain intensity
Time frame: 24 weeks
Illicit drug use
DAST-10 Drug screening questionnaire. Ten yes/no items scored 0 or 1. Score range 0-10
Time frame: 24 weeks
Problem alcohol use
AUDIT-C Alcohol Use Disorders Indentification Test
Time frame: 24 weeks
Past-month cannabis use
Monitoring the Future cannabis frequency questions
Time frame: 24 weeks
satisfaction with pain care
HUNT3 study- patient experience with PCP. 3 items scored 0-10. Range 0-30
Time frame: 24 weeks
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