Reducing Unused Prescribed Opioids After Cesarean Birth

项目总结/摘要 在过去的15年里，美国出现了药物过量的阿片类药物流行病 是意外死亡的最常见原因。药物过量死亡人数的增加反映了 法律的阿片类药物处方。不幸的是，大多数使用阿片类药物用于非医疗目的的人从以下来源获得它们： 合法服用阿片类药物的家庭成员或朋友。虽然受到了极大的关注， 致力于为患有慢性疼痛和急性手术后疼痛的个人提供处方建议， 对出院后手术后阿片类药物处方的关注要少得多。作为最 在美国常见的腹部手术中，剖腹产是理想的检查方法， 减少未使用的处方阿片类药物。我的初步研究表明，大多数妇女都有未使用的阿片类药物， 然而，在剖腹产后，很大一部分妇女使用所有阿片类药物，疼痛需求未得到满足。在 此外，目前的阿片类药物处方实践似乎主要基于处方者的习惯，而不是 病人的需要。这项工作的主体努力1）表征出院后阿片类药物使用模式，并确定 与差异使用相关的人口统计学和产科变量2）创建并验证临床决策 预测定制出院后阿片类药物需求的支持工具和3）进行试点随机临床试验 将CDS工具指导的处方与标准护理进行比较，以测试该工具是否减少了未使用的 阿片类药物不会增加剖宫产后未满足的疼痛。这个指导职业的首要目标是 发展经验是作为一个独立的临床研究者领导一个多学科 改善出院后阿片类药物处方的研究计划。为了实现这一目标，我将 通过预测建模方面的高级课程和技能开发来增强我之前的研究培训 开展临床试验以及领导力培训，重点是阿片类药物处方和孕产妇和 幼儿公共卫生系统。在整个授予期间，I将与多学科团队密切合作 包括妇产科、生物统计学、麻醉学、公共卫生和社会科学领域的专家， 健康和流行病学-实现我所陈述的职业目标和具体目标。

PROJECT SUMMARY/ABSTRACT Over the past 15 years, the United States has seen the emergence of an opioid epidemic with drug overdose ranking as the most common cause for accidental death. The rise in drug overdose deaths mirrors the rise in legal opioid prescribing. Unfortunately, most persons using opioids for non-medical purposes obtain them from a family member or friend who was legitimately prescribed opioids. While significant attention has been devoted to prescribing recommendations for individuals with chronic pain and for acute post-surgical pain, much less attention has been given to post-surgical opioid prescribing after hospital discharge. As the most common abdominal surgery in the United States, cesarean birth is the ideal setting to examine methods to reduce unused prescribed opioids. My preliminary work demonstrates that most women have unused opioids after cesarean birth, however a significant proportion of women use all opioids and have unmet pain needs. In addition, current opioid prescribing practices appear to be largely based on prescriber habits rather than patient need. This body of work endeavors to 1) characterize post-discharge opioid use patterns and identify demographic and obstetric variables associated with differential use 2) create and validate a clinical decision support tool that predicts customized post-discharge opioid need and 3) conduct a pilot randomized clinical trial comparing prescribing guided by the CDS tool to standard care to test whether this tool reduces unused opioids without increasing unmet pain after cesarean birth. The overarching objective of this mentored career development experience is to emerge as an independent clinical investigator leading a multidisciplinary research program to improve opioid prescribing after hospital discharge. To accomplish this goal, I will augment my prior research training with advanced coursework and skills development in predictive modeling and conducting clinical trials as well as leadership training focused on opioid prescribing and maternal and infant public health systems. Throughout the award period, the I will work closely with a multidisciplinary team of mentors and advisors—including experts in obstetrics and gynecology, biostatistics, anesthesiology, public health, and epidemiology—to carry out my stated career objectives and specific aims.