Effects of VHA opioid policy on prescribing and patient-centered outcomes

VHA 阿片类药物政策对处方和以患者为中心的结果的影响

• 批准号: 10200819
• 负责人: Erin Elizabeth Krebs
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200819
• 关键词: Acupuncture Therapy; Address; Affect; Attitude; Awareness; Behavior; Caring; Characteristics; Chronic Disease; Clinical; Collection; Complement; Complementary and alternative medicine; Data; Data Analyses; Data Collection; Data Reporting; Data Set; Dose; Effectiveness; Epidemic; Equilibrium; Event; Goals; Health Personnel; Individual; Informed Consent; Knowledge; Longitudinal Surveys; Methods; Modeling; Opioid; Opioid Analgesics; Outcome; Overdose; Pain; Pain management; Pain quality; Patient Care; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Perception; Pharmaceutical Preparations; Policies; Population; Primary Health Care; Process; Provider; Public Health; Quality of life; Questionnaires; Reporting; Research; Risk Management; Safety; Sampling; Standardization; Surveys; System; Telephone; Time; Urine; Veterans; addiction; chronic pain; chronic pain patient; dashboard; drug testing; follow-up; health administration; health related quality of life; high risk; improved; longitudinal design; non-opioid analgesic; opioid epidemic; opioid policy; opioid therapy; pain model; pain outcome; pain patient; pain rehabilitation; pain relief; patient oriented; patient population; prescription opioid; primary outcome; programs; prospective; response; tool; trend

 DESCRIPTION (provided by applicant): Background: Chronic pain is an important public health problem and among the most prevalent and disabling of chronic diseases. After two decades of sustained prescribing increases, opioid analgesics are the most commonly prescribed medications for chronic pain; however, evidence for long-term opioid effectiveness is insufficient. Now, an emerging public health epidemic of opioid-related harms-especially abuse and overdose-has triggered a new era in opioid attitudes and policies, in which opioid prescribing trends are being actively reversed. The Veterans Health Administration (VHA) has been a national leader in pain management-in early initiatives to promote greater awareness of pain, in efforts to expand access to a stepped care model of pain treatment, and in responses to the emerging epidemic of serious opioid-related harms. Recent VHA opioid policies include mandatory written informed consent for long-term opioid therapy and system-wide opioid safety goals to increase use of opioid risk management tools and decrease high-risk prescribing (e.g., high-dose opioid therapy). Because these VHA mandates are being implemented in a larger context of markedly changed attitudes towards opioids and because they are modeled on prior policies that have effectively reduced opioid prescribing, they are anticipated to substantially reduce rates and intensity of opioid prescribing in VHA. If successful, VHA initiatives will reduce potentially hazardous and excessive prescribing of opioids and improve pain and quality of life (QOL) outcomes among Veterans with chronic pain. Objectives: The main objective is to understand patient-centered outcomes of opioid prescribing changes among Veterans treated with opioids for chronic pain. The project will survey a nationally-representative sample of VA primary care patients receiving long-term opioid therapy to collect longitudinal patient-reported pain outcomes data. Specific aims are to examine, among patients receiving long-term opioid therapy, 1) the relationship between changes in opioid daily dose and changes in patient-reported pain and QOL outcomes; and 2) associations of patient, provider, and facility factors with changes in patient-reported pain and health- related QOL, primarily through their influence on opioid daily dose and use of non-pharmacological pain therapies. Methods: Existing data from VHA datasets will be used to identify VA patients prescribed long-term opioids (defined as = 6 consecutive months) for chronic pain. From this population, a nationally representative sample of 13,675 VA primary care patients receiving long-term opioid therapy will be identified using a multi-stage random sampling strategy. Patients included in the sample will be invited to participate in a longitudinal survey and complete brief questionnaires at three time points (baseline, 12 months, and 24 months). Following established methods for maximizing response to mailed surveys, eligible patients will be contacted multiple times by mail for each data collection time point, with a final telephone follow-up for non-responders. Questionnaires will assess pain-related function and health-related QOL as the primary outcomes and will assess pain characteristics, patient perception of treatment, and aspects of the patient-provider relationship as covariates. VHA administrative data will be used to assess patient use of non-pharmacological pain therapies and patient, provider, and facility covariates. Prospective patient-reported survey data will be merged with administrative data for analyses to address the specific aims.

 描述（由申请人提供）： 背景：慢性疼痛是一个重要的公共卫生问题，也是最普遍和最致残的慢性疾病之一。经过二十年的持续增加，阿片类镇痛药已成为治疗慢性疼痛最常用的药物。然而，阿片类药物长期有效性的证据尚不充分。现在，阿片类药物相关危害（尤其是滥用和过量）的公共卫生流行病引发了阿片类药物态度和政策的新时代，阿片类药物处方趋势正在积极扭转。退伍军人健康管理局 (VHA) 一直是疼痛管理领域的全国领导者，在早期举措中提高人们对疼痛的认识，努力扩大疼痛治疗的阶梯式护理模式，并应对新出现的严重阿片类药物相关危害的流行。最近的 VHA 阿片类药物政策包括长期阿片类药物治疗的强制性书面知情同意书和全系统阿片类药物安全目标，以增加阿片类药物风险管理工具的使用并减少高风险处方（例如高剂量阿片类药物治疗）。由于这些 VHA 指令是在人们对阿片类药物态度显着改变的大背景下实施的，并且因为它们是以有效减少阿片类药物处方的先前政策为蓝本的，因此预计它们将大幅降低阿片类药物处方的比率和强度 在VHA中。如果成功，VHA 计划将减少阿片类药物的潜在危险和过度处方，并改善患有慢性疼痛的退伍军人的疼痛和生活质量 (QOL) 结果。目标：主要目标是了解接受阿片类药物治疗慢性疼痛的退伍军人中以患者为中心的阿片类药物处方变化的结果。该项目将调查接受长期阿片类药物治疗的退伍军人事务部初级保健患者的全国代表性样本，以收集患者报告的纵向疼痛结果数据。具体目的是在接受长期阿片类药物治疗的患者中检查：1）阿片类药物每日剂量的变化与患者报告的疼痛和生活质量结果的变化之间的关系； 2) 患者、提供者和设施因素与患者报告的疼痛和健康相关生活质量变化的关联，主要是通过它们对阿片类药物每日剂量和非药物疼痛疗法的使用的影响。方法：VHA 数据集中的现有数据将用于识别因慢性疼痛而长期服用阿片类药物（定义为连续 6 个月）的 VA 患者。将使用多阶段随机抽样策略从该人群中确定 13,675 名接受长期阿片类药物治疗的 VA 初级保健患者的全国代表性样本。样本中包含的患者将被邀请参加纵向研究 在三个时间点（基线、12 个月和 24 个月）进行调查并完成简短的问卷调查。按照既定方法，最大限度地响应邮寄调查，将在每个数据收集时间点通过邮件多次联系符合条件的患者，并提供最终结果 对未答复者进行电话跟进。问卷将评估疼痛相关功能和健康相关生活质量作为主要结果，并将评估疼痛特征、患者对治疗的看法以及患者与提供者关系的各个方面作为协变量。 VHA 管理数据将用于评估患者对非药物疼痛疗法的使用以及患者、提供者和机构的协变量。患者报告的前瞻性调查数据将与管理数据合并进行分析，以实现特定目标。