{"doi":"10.1136/tsaco-2022-001038","title":"Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization","abstract":"<jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>Decreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>This longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP’s identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>The PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP’s office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>This level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence</jats:title>\n                  <jats:p>Level IV.</jats:p>\n               </jats:sec>","journal":"Trauma Surgery &amp; Acute Care Open","year":2023,"id":627186,"datarank":0.29188652235829704,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.0,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1622854,"name":"Laura A Katers","orcid":null,"position":1,"is_corresponding":false},{"id":259941,"name":"Mark D. Sullivan","orcid":"0000-0002-4396-6038","position":2,"is_corresponding":false},{"id":407438,"name":"Debra B. Gordon","orcid":"0000-0003-1946-2515","position":3,"is_corresponding":false},{"id":1622855,"name":"Adrienne James","orcid":null,"position":4,"is_corresponding":false},{"id":1622856,"name":"David J Tauben","orcid":null,"position":5,"is_corresponding":false},{"id":509946,"name":"Saman Arbabi","orcid":"0000-0002-1006-9664","position":6,"is_corresponding":false},{"id":430948,"name":"Laura‐Mae Baldwin","orcid":"0000-0002-2236-1216","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization","abstract":"<jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>Decreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>This longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP’s identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>The PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP’s office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>This level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence</jats:title>\n                  <jats:p>Level IV.</jats:p>\n               </jats:sec>","is_dataset_classified":null,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"36844370","pmcid":"PMC9944266","openalex_id":"https://openalex.org/W4321370739","authors":[],"funders":[{"funder_name":"Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control","grant_id":"R49CE003087","title":null},{"funder_name":"National Institutes of Health","grant_id":"5R49CE003087-03","title":"CE19-001, Injury Health-related Equity across the Lifespan (iHeal)"},{"funder_name":"CDC","grant_id":"","title":null}],"total_grants":3,"fwci":1.4363,"citation_percentile":0.80120658,"influential_citations":0,"citation_trend":[{"year":2024,"count":2},{"year":2025,"count":3},{"year":2026,"count":1}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://tsaco.bmj.com/content/tsaco/8/1/e001038.full.pdf","host_type":"journal"},{"url":"https://tsaco.bmj.com/content/tsaco/8/1/e001038.full.pdf","host_type":"publisher"},{"url":"https://syndication.highwire.org/content/doi/10.1136/tsaco-2022-001038","host_type":"publisher"},{"url":"https://doi.org/10.1136/tsaco-2022-001038","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/36844370","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9944266","host_type":"repository"},{"url":"https://doaj.org/article/1b02768d96464c41a5d69b0da5994a03","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9944266/pdf/tsaco-2022-001038.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC9944266","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC9944266?pdf=render","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.1136/tsaco-2022-001038","host_type":""}],"fields_of_study":["Opioid Use Disorder Treatment","Pain Management and Opioid Use","Pediatric Pain Management Techniques","03 medical and health sciences","0302 clinical medicine"],"mesh_terms":[],"keywords":["Trauma center","Medicine","Randomized controlled trial","Medical prescription","Intervention (counseling)","Opioid overdose","Emergency department","Opioid","Emergency medicine","Opioid use disorder","Medical emergency","Family medicine","Nursing","(+)-Naloxone","Retrospective cohort study","Internal medicine","Implementation","Delivery Of Health Care","Analgesics, Opioid","Health Care Quality, Access, And Evaluation","RD1-811","RC86-88.9","Surgery","Medical emergencies. 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