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

减少接受阿片类药物治疗术后疼痛的西班牙语患者的种族和语言差异

• 批准号: 10440110
• 负责人: Jeffrey Lawrence Schnipper
• 金额: $ 17.9万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10440110
• 关键词: Acute; Acute Pain; Caregivers; Caring; Cessation of life; Chronic; Communication; Counseling; Data; Day Surgery; Development; Dose; Education; Emergency department visit; Enrollment; Ensure; Ethnic Origin; Family; Goals; Hospitalization; Hospitals; Intervention; Language; Latino; Measures; Monitor; National Institute of Drug Abuse; Operative Surgical Procedures; Opioid; Opioid Analgesics; Orthopedic Surgery; Orthopedics; Outcome; Outpatients; Overdose; Pain; Pain management; Parents; Participant; Patient Self-Report; Patients; Pharmacists; Physical Function; Physicians; Pilot Projects; Population; Postoperative Care; Postoperative Pain; Postoperative Period; Prescription opioid overdose; Prevention; Prevention program; Provider; Research; Research Personnel; Risk Factors; Self Administration; Standardization; Subgroup; Suggestion; Surgeon; Surgical Management; Symptoms; Testing; Time; Translating; Treatment Efficacy; United States; Visit; base; bilingualism; chronic pain; cohort; community setting; design; disparity reduction; ethnic disparity; feasibility testing; follow-up; health care disparity; health care service utilization; health disparity; health information technology; improved; intervention program; member; mobile application; morphine equivalent; multi-component intervention; non-opioid analgesic; opioid epidemic; opioid misuse; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; patient engagement; patient population; prescription opioid; prevent; primary outcome; secondary outcome; stem; substance use treatment; synthetic opioid; treatment services; working group

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.

美国正处于阿片类药物使用危机之中，其中阿片类药物死亡人数令人不安地上升 阿片类药物使用障碍 (OUD) 的过量服用以及破坏性的个人和社会影响。 OUD 通常以 处方阿片类药物的使用，例如用于治疗术后患者的中度至重度疼痛。 先前的研究表明，大量接受阿片类药物用于普通手术的患者 程序发展了阿片类药物的持续使用，这是走向 OUD 及其后遗症的必要的第一步。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对其进行有效使用，从而有助于遏制阿片类药物使用危机的浪潮 管理患者的疼痛。 本研究的目的是设计和试点测试多方面持续使用阿片类药物的可行性 预防计划 (MOPP) 支持更安全的阿片类药物处方、自我管理和监测，以及 减少重大疾病后过渡到社区环境的患者的持续阿片类药物使用和阿片类药物滥用 骨科手术。多方位的干预包括：1）药剂师主导的患者出院咨询 护理人员以及与出院后提供者的沟通； 2) 标准化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（额外联系 根据需要）嵌入常规术后护理中，以控制疼痛和阿片类药物的使用； 4) 患者 用于评估疼痛、功能和 OUD 可能发展的参与疼痛管理应用程序。这些 先前关于长期使用阿片类药物的研究已显示出其成分的前景，但此前尚未得到证实 在此人群中结合实施或评估，以防止持续使用阿片类药物。这 MOPP 的设计及其实施将持续由患者家庭咨询委员会和 多元化的利益相关者指导委员会和跨学科工作组。该研究的主要结果是 干预措施将是根据全州处方数据持续使用阿片类药物（手术后 6 个月内）。 次要结果将包括长期阿片类药物发作；处方中阿片类药物的吗啡当量剂量 释放;术后 6 个月内分配的术后阿片类药物总量；自我报告的疼痛、功能、 术后 90 和 180 天出现提示阿片类药物滥用的体征或症状；以及术后 医疗保健利用。在本补充文件中，我们将为患者创建专用的西班牙语版本 应用程序，过度招募西班牙语和拉丁裔患者（因此他们占前两个队列的三分之一） 研究阶段），并在仅针对拉丁裔/西班牙语患者的研究期间添加第 3 阶段，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收益，并确定干预措施减少的能力 语言和种族在疼痛管理和持续使用阿片类药物方面存在差异。

项目成果

Perioperative and Periprocedural anesthetic management of opioid tolerant patients and patients with active and medically treated opioid use disorder.

• DOI: 10.1097/aco.0000000000001157
• 发表时间: 2022-08-01
• 期刊: Current opinion in anaesthesiology

Spanish translation and cultural linguistic validation of the Current Opioid Misuse Measurement (COMM-S).

当前阿片类药物滥用测量 (COMM-S) 的西班牙语翻译和文化语言验证。

• DOI: 10.1093/pm/pnad030
• 发表时间: 2023
• 期刊: Pain medicine (Malden, Mass.)
• 作者: Mendez-Pino,Laura;Villela-Franyutti,Diego;Schnipper,JeffreyL;Urman,RichardD;Corey,Sarah;Collins,PatrickW;Jamison,RobertN
• 通讯作者: Jamison,RobertN