Reducing ethnic and language disparities in Spanish-speaking patients who receive opioids for postsurgical pain

美国正处于阿片类药物使用危机之中，包括阿片类药物死亡人数令人不安的上升。 阿片类药物使用障碍(OUD)的过量和破坏性的个人和社会影响。OUD通常以 处方类阿片类药物的使用，如用于治疗术后患者的中度至重度疼痛。 先前的研究表明，相当数量的接受阿片类药物的患者用于普通外科手术 程序发展了持续的阿片类药物使用，这是走向OUD及其后遗症的必要的第一步。一个平衡的 迫切需要对手术患者进行术后疼痛管理，以防止持续的术后疼痛 在阿片类药物发展之前使用阿片类药物，从而有助于遏制阿片类药物使用危机的浪潮，同时仍 管理病人的痛苦。 这项研究的目的是设计和初步测试多方面持续使用阿片类药物的可行性 预防计划(MOPP)，以支持更安全的阿片类药物处方、自我给药和监测，以及 减少阿片类药物的持续使用和阿片类药物滥用 整形外科手术。多方面的干预措施包括：1)药师主导的出院咨询 和照顾者以及与出院后提供者的沟通；2)标准化的阿片类药物处方出院 每种手术类型的医嘱集；3)出院后疼痛管理随访(有额外联系 根据需要)嵌入常规术后护理以控制疼痛和阿片类药物的使用；以及4)患者 接洽疼痛管理应用程序，用于评估疼痛、功能和OUD的可能发展。这些 成分在先前的慢性阿片类药物使用研究中显示出了希望，但在此之前还没有 在这一人群中联合实施或评估，目的是防止持续使用阿片类药物。这个 MOPP的设计和实施将继续由患者-家庭咨询委员会和 不同利益攸关方指导委员会和跨学科工作组。改革的主要结果是 干预措施将是基于全州处方数据的持续阿片类药物使用(手术后6个月)。 次要结果将包括长期的阿片类药物发作；吗啡等量的阿片类药物处方在 出院；术后6个月内阿片类药物的使用总量；自我报告的疼痛、功能、 术后90天和180天出现阿片类药物滥用的体征或症状 医疗保健利用率。在本增刊中，我们将创建一个专门的西班牙语版本的患者 APP，超额招收讲西班牙语和拉丁裔的患者(因此他们在前两个队列中占三分之一 研究的阶段)，并在仅针对拉丁裔/西班牙语患者的研究期间增加阶段3，以便 我们可以根据语言和种族评估术后疼痛管理的基线差异，确定 西班牙语应用程序的增量好处，并确定干预的能力 在疼痛管理和持续使用阿片类药物方面存在语言和种族差异。

The United States is in the midst of an opioid use crisis, including a disturbing rise in deaths from opioid overdoses and devastating personal and societal effects of opioid use disorder (OUD). OUD often starts with prescription opioid use, such as for the treatment of moderate to severe pain in post-operative patients. Previous studies have shown that a substantial number of patients who receive opioids for common surgical procedures develop persistent opioid use, a necessary first step towards OUD and its sequelae. A balanced approach to postoperative pain management for surgical patients is urgently needed to prevent persistent post- operative opioid use before it develops, thus helping to stem the tide of the opioid use crisis while still managing patients’ pain. The objective of this study is to design and pilot test the feasibility of a Multi-faceted persistent Opioid use Prevention Program (MOPP) to support safer opioid prescribing, self-administration and monitoring, and reduce persistent opioid use and opioid misuse for patients transitioning to the community setting after major orthopedic surgery. The multi-faceted intervention includes: 1) pharmacist-led discharge counseling of patients and caregivers and communication with post-discharge providers; 2) standardized opioid prescribing discharge order sets for each surgery type; 3) a post-discharge pain management follow-up visit (with additional contact as needed) embedded within routine post-operative care for managing pain and opioid use; and 4) a patient engagement pain management app for assessing pain, function, and possible development of OUD. These components have shown promise in prior studies of chronic opioid use but have not been previously implemented or evaluated in combination in this population with a goal of preventing persistent opioid use. The design of MOPP and its implementation will be continuously guided by a patient-family advisory council and diverse stakeholder steering committee and interdisciplinary working group. The primary outcome of the intervention will be persistent opioid use (in the 6 months after surgery) based on state-wide prescription data. Secondary outcomes will include long-term opioid episodes; morphine-equivalent dose of opioids prescribed at discharge; total post-operative opioids dispensed in the 6 months after surgery; self-reported pain, function, and signs or symptoms suggestive of opioid misuse 90 and 180 days after surgery; and post-operative healthcare utilization. In this Supplement, we will create a dedicated Spanish-language version of the patient app, over-enroll Spanish-speaking and Latino patients (so they are one-third of the cohort in the first two stages of the study), and add a Stage 3 to the study period with Latino/Spanish-speaking patients only so that we can evaluate baseline disparities in post-operative pain management by language and ethnicity, determine the incremental benefits of the Spanish-language app, and determine the ability of the intervention to reduce disparities by language and ethnicity on pain management and persistent opioid use.