使用阿片类药物治疗慢性疼痛导致抑郁或焦虑的高发生率使共同管理变得复杂，并可能影响处方行为。比较电子病历临床决策支持 (EMR-CDS) 与额外行为健康 (BH) 护理管理在降低发生率方面的临床效果高剂量阿片类药物处方。在美国洛杉矶卫生系统内 35 个初级保健诊所进行的 2 型有效性实施混合阶梯楔形集群随机试验。18 岁患者接受慢性阿片类药物治疗，治疗伴有抑郁或焦虑的非癌性疼痛，并进行匹配EMR-CDS 包括阿片类药物风险缓解程序。 BH 护理包括认知行为治疗；抑郁症或焦虑症药物调整；感兴趣的结果包括对开大剂量吗啡当量每日剂量（MEDD ≥50 mg/天和 MEDD ≥90）的概率变化的双重差分 (DID) 估计、平均 MEDD 和住院率、急诊室使用以及阿片类药物风险缓解。大多数参与者是患有 3 种疼痛综合征的女性。数据分析包括 632 名患者。与指数前相比，MEDD≥50 和 ≥90 的绝对风险差异在指数后下降（绝对风险差的 DID [95%CI]：分别为 -0.036 [-0.089, 0.016] 和 -0.029 [-0.060, 0.002] ）。然而，这些差异在统计学上并不显着。与仅 EMR-CDS 相比，BH 组的平均 MEDD 下降速度更高（DID 率比 [95%CI]：0.85 [0.77，0.93]）。住院和急诊科使用情况没有变化。 BH 组获得纳洛酮和抗抑郁药新专科转诊和处方的可能性较高。将多学科行为健康护理团队纳入初级保健并没有减少高剂量处方；然而，它提高了对管理非癌性疼痛的慢性阿片类药物治疗的临床指南建议的遵守率。ClinicalTrials.gov ID NCT03889418.© 2024。作者获得普通内科医学会的独家许可。

High prevalence of depression or anxiety with opioid use for chronic pain complicates co-management and may influence prescribing behaviors.Compare clinical effectiveness of electronic medical record clinical decision support (EMR-CDS) versus additional behavioral health (BH) care management for reducing rates of high-dose opioid prescriptions.Type 2 effectiveness-implementation hybrid stepped-wedge cluster randomized trial in 35 primary care clinics within a health system in LA, USA.Patients aged 18+ receiving chronic opioid therapy for non-cancer pain with depression or anxiety and matched controls.EMR-CDS included opioid risk mitigation procedures. BH care included cognitive behavioral therapy; depression or anxiety medication adjustments; and case management.Outcomes of interest included difference-in-difference (DID) estimate of changes in probability for prescribing high-dose morphine equivalent daily dose (MEDD ≥50 mg/day and MEDD ≥90), average MEDD, and rates of hospitalization, emergency department use, and opioid risk mitigation.Most participants were female with 3+ pain syndromes. Data analysis included 632 patients. Absolute risk differences for MEDD≥50 and ≥90 decreased post-index compared to pre-index (DID of absolute risk difference [95%CI]: -0.036 [-0.089, 0.016] and -0.029 [-0.060, 0.002], respectively). However, these differences were not statistically significant. The average MEDD decreased at a higher rate for the BH group compared to EMR-CDS only (DID rate ratio [95%CI]: 0.85 [0.77, 0.93]). There were no changes in hospitalization and emergency department utilization. The BH group had higher probabilities of new specialty referrals and prescriptions for naloxone and antidepressants.Incorporation of a multidisciplinary behavioral health care team into primary care did not decrease high-dose prescribing; however, it improved adherence to clinical guideline recommendations for managing chronic opioid therapy for non-cancer pain.ClinicalTrials.gov ID NCT03889418.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.