The Effect of Medical Cannabis Laws on Health Care Use in Insured Populations with Pain-S1

医用大麻法对疼痛 S1 参保人群医疗保健使用的影响

• 批准号: 10393350
• 负责人: W David Bradford
• 金额: $ 56.92万
• 依托单位: UNIVERSITY OF GEORGIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10393350
• 关键词: Activities of Daily Living; Affect; Alcohol consumption; American College of Obstetricians and Gynecologists; Anxiety; Biological; COVID-19; COVID-19 pandemic; Cannabis; Censuses; Cesarean section; Characteristics; Clinical; Computerized Medical Record; Contracts; County; Data; Data Sources; General Population; Goals; Health; Health Care Visit; Health Services Accessibility; Healthcare; Hospitalization; Hospitals; Hour; Incidence; Individual; Infant; Laws; Lead; Measures; Medical Marijuana; Mental Depression; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Patients; Perinatal; Persistent pain; Persons; Population; Postpartum Period; Postpartum Women; Pregnant Women; Privatization; Provider; Public Health; Public Policy; Reporting; Risk; Running; Social isolation; Source; Stress; Time; United States; Vagina; Virus; Visit; Vulnerable Populations; Woman; barrier to care; base; behavioral response; chronic pain; experience; follow-up; health care availability; health care service utilization; health disparity; health of the mother; individual patient; longitudinal analysis; marijuana legalization; marijuana use; maternal morbidity; member; mortality; non-opioid analgesic; novel; opioid use; opportunity cost; pandemic disease; parent grant; postpartum care; postpartum health; postpartum morbidity; prenatal; prescription opioid; prescription pain reliever; rural residence; service intervention

Project Summary The COVID-19 pandemic has substantially disrupted routine healthcare and exacerbated existing barriers to healthcare access for the population. Our proposal will provide new evidence on the impact of the COVID-19 pandemic for a particularly vulnerable population: postpartum women. Approximately two-thirds of women report pain that interferes with Activities of Daily Living at 24 hours postpartum; 6 to 18% of women experience chronic pain after delivery. Thus, disruption to routine healthcare has the potential to substantially worsen pain and subsequent health for postpartum women. Our proposed study will examine the effect of the COVID-19 pandemic on postpartum women’s pain-related healthcare utilization, with specific focus on the prescription of opioid analgesics at hospital discharge after delivery and during the subsequent six-month postpartum period. In addition, we will examine the extent to which the impact of the pandemic differed systematically for women with versus without access to recreational or medical cannabis, thus building on preliminary evidence that there is substitution away from opioid analgesic prescriptions in states that implement recreational and medical cannabis laws. Our analyses will leverage data from two large secondary data sources: Optum claims data and HealthJump electronic medical records data, in conjunction with data on active cannabis dispensaries and U.S. Census data. We will employ a patient-level panel data approach to examine changes in healthcare utilization that coincided with the start of the COVID-19 pandemic, controlling for individual patient characteristics, state and county time-varying characteristics, and state fixed effects. In addition, we will interact our measure of pandemic exposure with measures of access to legal cannabis and conduct sub-analyses in which we allow for potential differential effects by delivery type (vaginal or Cesarean), by prior opioid use, and by urban versus rural residence. These novel analyses will provide the first longitudinal, patient-level analysis of the relationship between COVID-19 and pain-related healthcare utilization for postpartum women, as well as the first evidence on the interaction between legal cannabis access and utilization of prescription pain medication among postpartum women. Understanding these relationships is essential in order to optimize public policies and to provide guidance to clinical practitioners on mitigation of long-run impacts of the COVID-19 pandemic.

项目摘要 COVID-19大流行严重扰乱了常规医疗保健，并加剧了现有的 为人民提供医疗服务。我们的提案将为COVID-19的影响提供新的证据 这一流行病对特别脆弱的人群-产后妇女-危害极大。大约三分之二的女性 报告产后24小时疼痛干扰日常生活活动; 6 - 18%的女性经历过 产后慢性疼痛因此，常规医疗保健的中断有可能大大加重疼痛 以及产后妇女的后续健康。 我们提议的研究将检查COVID-19大流行对产后妇女疼痛相关的影响。 医疗保健利用，特别关注出院时阿片类镇痛药的处方， 分娩和产后6个月期间。此外，我们还将研究 这一流行病的影响对有和没有娱乐机会的妇女有系统的不同， 或医用大麻，从而建立在初步证据的基础上， 实施娱乐和医疗大麻法律的州的处方。 我们的分析将利用来自两个大型二级数据源的数据：Optum索赔数据和HealthJump 电子医疗记录数据，以及关于活跃的大麻药房和美国人口普查的数据 数据我们将采用患者层面的面板数据方法来检查医疗保健利用的变化， 恰逢COVID-19大流行开始，控制个体患者特征，状态和 县随时间变化的特点，和国家固定的影响。此外，我们将与我们的措施相互作用， 大流行暴露与措施获得法律的大麻和进行子分析，其中我们允许 按分娩类型（阴道或剖腹产）、既往阿片类药物使用以及城市与 农村住宅。 这些新的分析将提供第一个纵向的，患者水平的分析之间的关系， COVID-19和产后妇女疼痛相关的医疗保健利用，以及关于 产后妇女法律的大麻获取与处方止痛药使用之间的相互作用 妇女了解这些关系对于优化公共政策和提供 为临床医生提供有关减轻COVID-19疫情长期影响的指导。