Unintended Prolonged Opioid Use

意外长期使用阿片类药物

• 批准号: 10472460
• 负责人: W. Michael Hooten
• 金额: $ 116.18万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10472460
• 关键词: Address; Adoption; Adult; Attitude; Belief; Biochemical; Characteristics; Clinic; Clinical; Clinical Research; County; Data Set; Data Sources; Databases; Development; Disincentive; Drug Prescriptions; Electronic Health Record; Elements; Enrollment; Environment; Equation; Geography; Guidelines; Health; Healthcare; Incentives; Institution; Intervention; Knowledge; Literature; Measures; Mediating; Medical; Medical Record Linkage; Michigan; Minnesota; Modeling; Opioid; Pain; Pain management; Patient Recruitments; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacy facility; Population; Prevention strategy; Prospective Studies; Public Health; Questionnaires; Recording of previous events; Records; Research; Research Personnel; Retrospective Studies; Risk; Sampling; Secure; Site; Source; Study Subject; System; Testing; Time; Training; Translational Research; Universities; Work; clinical research site; cloud based; data mining; design; health care settings; innovation; interoperability; mHealth; medical schools; opioid epidemic; opioid use; patient population; prescription opioid; prescription opioid abuse; prescription opioid misuse; prevent; prospective; psychologic; recruit; social; wearable device

PROJECT SUMMARY Misuse of prescription opioids remains a public health crisis. Appropriate short-term use of these medications in opioid-naïve patients is indicated in select health care settings, but intentional short-term use is emerging as a previously under-recognized segue to unintended prolonged opioid use (UPOU). Clinical strategies aimed at preventing UPOU in health care settings are lacking due, in part, to absence of information about how this poorly-understood clinical phenomenon develops. Investigators at Mayo Clinic recently organized a group of thought leaders to develop a conceptual framework to explain UPOU. Such a framework is essential both to guide the study of this problem and to identify potential targets for interventions to reduce UPOU. The framework is comprised of three domains, including (1) patient characteristics; (2) practice environment characteristics; and (3) opioid prescriber characteristics that interact to either facilitate or impede UPOU. Within each domain, potential factors, drawn from the relevant literature, moderate or mediate the influence of each domain. However, much of the information needed to evaluate this framework does not currently exist. The widespread adoption of electronic health records (EHR) provides unique potential opportunities for translational research, including identifying subjects eligible for study participation and serving as a data sources for retrospective or prospective studies. However, interoperability between EHRs poses a considerable challenge to taking advantage of these opportunities. Researchers at the Yale School of Medicine recently launched Hugo, a secure mobile personal health (mHealth) platform that enables patients to access their information from multiple EHRs and other healthcare information sources, including commercial pharmacy records. The Hugo platform has tremendous potential to facilitate clinical research, especially research conducted across multiple centers – as information from diverse source systems at each institution can be easily integrated into a common dataset. In this application, four CTSA hubs (Mayo Clinic, University of Minnesota, University of Michigan, and Yale) will explore the Hugo platform's potential to facilitate clinical research, with the UPOU study as a use case. We will use the Hugo platform to identify incident cases of UPOU and prospectively recruit patients and opioid prescribers for assessments, as well as to evaluate the proposed conceptual framework using structural equation models. At this study's conclusion, we will have successfully deployed a highly innovative mHealth platform across multiple centers and this platform will be immediately available for widespread dissemination across the entire CTSA consortium and other clinical research sites. The information gained about UPOU will significantly advance core knowledge about this poorly understood clinical phenomenon. This newly acquired information will be used design, test, and deploy prevention strategies aimed at mitigating the risks of UPOU.

项目总结 滥用处方阿片类药物仍然是一个公共卫生危机。这些药物的适当短期使用 对于阿片类药物单纯的患者，在选定的医疗保健环境中被表明，但故意的短期使用正在出现为 以前未被认识到的非故意长期使用阿片类药物(UPOU)。针对以下目标的临床策略 在卫生保健环境中缺乏预防UPOU的部分原因是缺乏关于如何做到这一点的信息 人们对临床现象知之甚少。 梅奥诊所的研究人员最近组织了一个思想领袖小组来开发一个概念性框架 来解释UPOU。这样一个框架对于指导对这一问题的研究和确定潜力都是必不可少的。 减少UPOU的干预目标。该框架由三个领域组成，包括(1)患者 特征；(2)执业环境特征；以及(3)阿片类处方者特征 要么为UPOU提供便利，要么阻碍UPOU。在每个领域内，从相关文献中提取的潜在因素， 缓和或调和每个领域的影响。然而，评估这一点所需的大部分信息 框架当前不存在。电子健康记录(EHR)的广泛采用提供了 翻译研究的独特潜在机会，包括确定符合研究条件的对象 参与并作为回顾或前瞻性研究的数据来源。然而，互操作性 EHR之间的合作对利用这些机会构成了相当大的挑战。 耶鲁大学医学院的研究人员最近推出了一款安全的移动个人健康产品Hugo (MHealth)平台，使患者能够从多个EHR和其他医疗保健机构访问他们的信息 信息来源，包括商业药房记录。Hugo平台具有巨大的潜力 促进临床研究，特别是跨多个中心进行的研究-作为来自不同中心的信息 每个机构的源系统都可以很容易地集成到一个公共数据集中。 在此应用程序中，四个CTSA中心(梅奥诊所、明尼苏达大学、密歇根大学和耶鲁大学)将 以UPOU研究为用例，探索Hugo平台促进临床研究的潜力。我们会 使用Hugo平台识别UPOU事件病例，并前瞻性招募患者和阿片类药物 评估的处方人员，以及使用结构评估拟议的概念框架 方程式模型。在这项研究的结论中，我们将成功部署一个高度创新的mHealth 跨多个中心的平台，该平台将立即可用于广泛传播 在整个CTSA联盟和其他临床研究地点。获得的关于UPOU的信息将 极大地提高了关于这种鲜为人知的临床现象的核心知识。这是新获得的 将利用这些信息来设计、测试和部署旨在减轻UPOU风险的预防战略。

项目成果

Opioid Management: Initiating, Monitoring, and Tapering.

阿片类药物管理：启动、监测和逐渐减少。

• DOI: 10.1016/j.pmr.2020.01.006
• 发表时间: 2020
• 期刊: Physical medicine and rehabilitation clinics of North America
• 影响因子: 1.7
• 作者: Hooten,WMichael