April 27, 2020
PAR-18-222, Multi-Site Studies for System-Level Implementation of Substance Use Prevention and Treatment Services (R01 Clinical Trial Optional)
All applications to this funding opportunity announcement should fall within the mission of the Institutes/Centers. The following NIH Offices may co-fund applications assigned to those Institutes/Centers.
Office of Behavioral and Social Sciences Research (OBSSR)
In response to the dramatic rise in U.S. opioid overdose deaths, professional organizations and federal agencies created clinical guidelines to educate health care professionals on proper pain management with opioid analgesics, non-opioid medications, and non-pharmacological treatments. In general, these guidelines suggest non-opioid analgesics as the frontline option for managing acute pain; advise the use of fast-acting opioid analgesics at the lowest therapeutic dose for the shortest amount of time; encourage consideration of the relative risk and benefits of opioid tapering for individuals who meet high morphine milligram equivalents; discourage benzodiazepine and opioid co-prescribing; and recommend naloxone for high risk patients. Indeed, US prescribing rates have dropped nearly 20% from 2006 to 2017 and improved prescribing behaviors in many cases, especially for primary care physicians. However, in some cases, these guidelines have been misapplied, leading some health care professionals to stop prescribing opioids altogether, when the use or continuation of opioids may have been clinically appropriate. This has resulted in other unintended consequences, including improper pain management, suicide, and cessation of health care utilization for other associated illnesses.
Pain presents itself in every health care setting, but the absence of specialized knowledge to address it leads to fragmented care and/or patient loss as they navigate the healthcare system to balance pain management against opioid related health benefits and consequences. Given this context, there is a need to understand effective strategies to shape opioid prescribing and pain management behaviors of health care providers -- how to engage prescribers, how to maintain changes in behavior, and how to best convey balanced assessments of the associated harms and benefits of opioid analgesics for the effective management of pain. To maximize impact, implementation research is needed to develop strategies that can change prescribing behaviors at a system level.
This NOSI seeks applications that will test multifaceted implementation strategies for evidence-based clinical guidelines on opioid prescribing for pain management, in order to (1) increase guideline-concordant clinical care behaviors; (2) generate measurable, timely, and sustainable changes in clinical behavior across entire healthcare systems; and (3) improve patient outcomes.
Applications will respond to PAR-18-222 (or any subsequent reissues). This FOA seeks multi-site system-level implementation trials.
Applicants are strongly encouraged to speak with program staff prior to developing an application.
Application and Submission Information
This notice applies to due dates on or after July 17, 2020 and subsequent receipt dates through January 8, 2023.
Submit applications for this initiative using the following funding opportunity announcement (FOA) or any reissues of this announcement through the expiration date of this notice:
All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions: