Diagnosing and Treating Veterans with Chronic Pain and Opioid Misuse
诊断和治疗患有慢性疼痛和阿片类药物滥用的退伍军人
基本信息
- 批准号:10595496
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-01-01 至 2025-12-31
- 项目状态:未结题
- 来源:
- 关键词:AddressAffectAlgorithmsAmericanAnalgesicsAreaBuprenorphineCaringCenters for Disease Control and Prevention (U.S.)ClassificationClinicalComputerized Medical RecordConsumptionCountryDataDiagnosisDiagnosticDocumentationDoseEffectivenessElasticityEnrollmentEvidence based treatmentExclusionExhibitsFeedbackFrightFundingFutureGeneral PopulationGoalsGuidelinesHarm ReductionHealthHealth Services AccessibilityHealth Services ResearchIndividualInternational Classification of Disease CodesInterventionInterviewKnowledgeMental HealthMethodologyMethodsOpioidOpioid RotationOutcomeOverdosePainPain intensityPain managementPatient Self-ReportPatient-Focused OutcomesPatientsPharmaceutical PreparationsPharmacological TreatmentPharmacy facilityPopulationProcessProviderQualitative MethodsResearchResearch DesignRiskRisk BehaviorsSafetySamplingScreening procedureSelection BiasSigns and SymptomsSiteSpeedStructureSymptomsTestingTranslatingVeteransVeterans Health AdministrationWithdrawalWorkaddictionadverse outcomechronic painchronic pain managementchronic pain patientclinical practiceclinical research sitecohortcomparative effectivenesscomparative efficacycompare effectivenesscostdata warehousediagnostic criteriaeffective therapyevidence baseexperiencefallshigh riskimprovedinnovationlarge datasetsmedication for opioid use disordernovelopioid misuseopioid taperingopioid therapyopioid use disorderpatient orientedpatient populationpatient safetyprescription opioidprescription opioid misuserandomized, clinical trialsrecruitresearch and developmentsafety outcomessecondary analysisstructured datastudy populationsymptomatic improvementtooltreatment strategytrial readiness
项目摘要
Background: As many as 30% of the ~10 million Americans prescribed long-term opioid therapy (LTOT) are
estimated to misuse opioids. Receiving LTOT is associated with opioid-related harms, and misuse leads to an
increase in the dose consumed and other risky behavior, further worsening outcomes. However, there is a gap
in knowledge on how to identify and treat this patient population particularly when they do not meet diagnostic
criteria to be treated by medications for Opioid Use Disorder (OUD). In recent years, guidelines from the
Centers for Disease Control and the Veterans Health Administration (VHA) have effected widespread tapering
to reduce misuse. Buprenorphine, a medication used for both pain and OUD, may also be effective in reducing
opioid-related harms while controlling pain for patients on LTOT with misuse; however, buprenorphine is yet to
be tested rigorously in this patient population. Therefore, studies are needed to identify patients on LTOT with
misuse and to compare the efficacy of different treatments on patient outcomes.
Significance: Chronic pain, LTOT for pain, and opioid misuse are common among Veterans and lead to
multiple health-related harms. The VHA has made improving pain care and reducing opioid harms a major
priority of clinical initiatives, and this proposal responds to the Health Services Research and Development
(HSR&D) Funding Announcement #HX-21-024 to address those opioid-related priorities. By filling a crucial
evidence gap, this proposal will significantly impact the way we treat pain and minimize harm for Veterans with
opioid misuse.
Innovation and Impact: This proposal is innovative and impactful in many ways. First, this project will utilize the
unique capabilities of the VHA’s Corporate Data Warehouse (CDW) to develop a novel algorithm to identify
patients on LTOT with misuse. If successful, this automated identification process has the potential to be
scaled to VHA sites across the country. Second, the comparative effectiveness of different treatments will be
determined by an emulated trial, an innovative and efficient study design that can lead to greater
generalizability than standard trials, which suffer significantly from selection bias in this area. The treatments
being evaluated in the emulated trial are readily available, so if specific treatments are found to improve patient
symptoms and reduce adverse outcomes, it will be feasible for Veterans with opioid misuse to access these
treatments nationwide. Finally, we will gather feedback from providers and Veterans to understand the best
strategies and interventions to scale the identification process and better inform Veterans and providers of
evidence-based treatment options.
Specific Aims: This project aims to 1) Classify a cohort of patients on LTOT with opioid misuse but without
OUD by a) building on a previously developed augmented chart review methodology and b) applying an
algorithm to structured data; 2) Conduct an emulated trial to compare the effectiveness of pharmacologic
treatment options on patient-centered and patient safety outcomes; and 3) Understand current practices and
how to translate our findings into improved care via semi-structured interviews with providers and Veterans.
Methodology: The study population is VHA patients on LTOT with opioid misuse 2014-present. The proposal
uses mixed quantitative and qualitative methods including augmented structured chart review, large dataset
classification using ordinal elastic net regression, emulated trials, and qualitative interviews.
Next Steps/Implementation: We expect findings to be of use to VHA leaders, prescribing clinicians, and
patients with chronic pain. If successful, the automated identification process from Aim 1 could be scaled to
VHA sites, and if treatments evaluated in Aim 2 are effective in improving symptoms and reducing adverse
outcomes, these could also be implemented widely. In Aim 3, we will gather Veteran input on how to best
implement findings from Aims 1 and Aim 2 into clinical practice in a variety of settings.
背景:在约1000万美国人的长期阿片类药物治疗(LTOT)中,有多达30%的人服用了阿片类药物
项目成果
期刊论文数量(0)
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Amy S B Bohnert其他文献
Amy S B Bohnert的其他文献
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{{ truncateString('Amy S B Bohnert', 18)}}的其他基金
Diagnosing and Treating Veterans with Chronic Pain and Opioid Misuse
诊断和治疗患有慢性疼痛和阿片类药物滥用的退伍军人
- 批准号:
10313694 - 财政年份:2022
- 资助金额:
-- - 项目类别:
Reducing Non-Medical Opioid Use: An automatically adaptive mHealth Intervention
减少非医疗阿片类药物的使用:自动适应的移动医疗干预措施
- 批准号:
9416993 - 财政年份:2016
- 资助金额:
-- - 项目类别:
Primary care intervention to reduce prescription opioid overdoses
初级保健干预减少处方阿片类药物过量
- 批准号:
10027245 - 财政年份:2015
- 资助金额:
-- - 项目类别:
Primary care intervention to reduce prescription opioid overdoses
初级保健干预减少处方阿片类药物过量
- 批准号:
10162313 - 财政年份:2015
- 资助金额:
-- - 项目类别:
Primary care intervention to reduce prescription opioid overdoses
初级保健干预减少处方阿片类药物过量
- 批准号:
10165792 - 财政年份:2015
- 资助金额:
-- - 项目类别:
Primary care intervention to reduce prescription opioid overdoses
初级保健干预减少处方阿片类药物过量
- 批准号:
9145508 - 财政年份:2015
- 资助金额:
-- - 项目类别:
Developing a Prescription Opioid Overdose Prevention Intervention
制定处方阿片类药物过量预防干预措施
- 批准号:
8636645 - 财政年份:2014
- 资助金额:
-- - 项目类别:
Developing a Prescription Opioid Overdose Prevention Intervention
制定处方阿片类药物过量预防干预措施
- 批准号:
8811923 - 财政年份:2014
- 资助金额:
-- - 项目类别:
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