Toward Safer Opioid Prescribing for Chronic Pain in High Risk Populations
Toward Safer Opioid Prescribing for Chronic Pain in High Risk Populations
The overarching plan for TOWER is to develop and test an algorithmic version of the Center
 for Disease Control Guidelines (CDCG) tailored for a specific primary care setting, the HIV
 primary care clinic. This CDCG intervention incorporates communication and implementation
 strategies tailored for the HIV primary care setting, and enabled with technology (an app for
 use by patients and EMR tools for providers).
However, according to a 2014 AHRQ report, there have been no studies evaluating the
 effectiveness of any prescription opioid risk mitigation strategies. Furthermore, due to
 ambiguity in some of the CDCG recommendations and the challenging nature of the
 patient-provider opioid conversation, the success of the CDCG may hinge on the manner in
 which it is implemented in individual care settings. Thus it is unclear what the true effect
 of the CDCG will be. The investigators believe that for the CDCG to have the greatest
 likelihood of achieving its goals of improving prescription opioid safety without causing
 unintended effects (e.g. exacerbation of pain, disruption of other aspects of care), its
 recommendations will need to be skillfully communicated. Furthermore, because of this "human
 element"and other sources of variability, documenting the effectiveness of the CDCG will
 require standardization of implementation. The overarching plan for TOWER is to develop and
 test an algorithmic version of the CDCG tailored for a specific primary care setting, the HIV
 primary care clinic. This CDCG intervention incorporates communication and implementation
 strategies tailored for the HIV primary care setting, and enabled with technology (an app for
 use by patients and EMR tools for providers). Achieving this goal has involved soliciting
 input from the HIV community using the method of Public Deliberation (PD) in the setting of
 two Citizen' s Panels, each with ~22 HIV-infected participants and lasting one day; and using
 the information obtained from the deliberative process to inform the development of the CDCG
 intervention. The investigators now plan to test the CDCG intervention for feasibility.
Inclusion Criteria:

 -  Attending physician or advance practice provider in one of the Institute of Advanced
 Medicine (IAM) clinics

 -  Designated PCP for at least 5 patients to whom he/she prescribes opioids

 -  Willing and able to adhere to study procedures including randomization, and refraining
 from discussion of study procedures with other clinical staff or patients

 Exclusion Criteria:

 -  Unwillingness to undergo randomization

 -  Plans to leave IAM within the study period.