Chronic Opioid Therapy and Patient Safety in HIV Infected and Uninfected Veterans

HIV 感染和未感染退伍军人的慢性阿片类药物治疗和患者安全

• 批准号: 8527077
• 负责人: Julie Rozelle Gaither
• 金额: $ 4.22万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8527077
• 关键词: Accidents; Accounting; Address; Adherence; Affect; Afghanistan; Aging; American; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chronic; Chronic Disease; Clinical; Clinical Research; Cocaine; Cohort Studies; Color; Conflict (Psychology); Country; Data; Data Analyses; Department of Defense; Drug Prescriptions; Economics; Growth; Guideline Adherence; Guidelines; HIV; Healthcare; Healthcare Systems; Heroin; Injury; Iraq; Link; Medicine; Mission; Modeling; Nurses; Opiate Addiction; Opioid; Outcome; Overdose; Pain; Pain management; Patient Monitoring; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Physicians; Play; Prospective Studies; Provider; Public Health; Relative Risks; Research; Resources; Risk; Risk Assessment; Role; Rosa; Safety; Sales; Societies; Source; Substance Use Disorder; Substance abuse problem; System; Testing; Training and Education; United States Department of Veterans Affairs; Veterans; Violence; Work; addiction; cancer pain; care seeking; clinical practice; disorder prevention; end of life; evidence base; falls; high risk; milligram; mortality; non-cancer pain; opioid abuse; overdose death; patient safety; prescription opioid; primary outcome; public health relevance; secondary outcome; trend; vehicular accident

DESCRIPTION: Prescription opioids, drugs once reserved for the treatment of end-of-life cancer pain, have recently become a mainstay in the treatment of chronic non-cancer pain (CNCP), a trend that is increasingly controversial. Limited data exist to support the safety and efficacy of chronic opioid therapy (i.e., long-term opioid use), and risk for misuse is elevated in patients with psychiatric illness and substance use disorders. Despite these concerns, prescriptions for CNCP continue to rise, as evidenced by the substantial growth in retail pharmacy sales in recent years: from 1997 to 2006, the number of opioid prescriptions dispensed in the U.S. increased by 48%, and the amount of medication dispensed per person rose by 368% (from 74 to 369 milligrams per capita, according to the U.S. Drug Enforcement Agency). Mirroring these trends has been a rise in unintentional overdose deaths and unprecedented levels of addiction to prescription drugs. These data underscore the need for clinician adherence to evidence-based opioid treatment guidelines, first introduced in 1997 to promote the safe and efficacious use of prescription opioids for CNCP management. The overall objective of this proposal is to describe clinician adherence to evidence-based opioid treatment guidelines and to examine the association between guideline adherence and patient safety, among HIV+ and HIV- patients. We hypothesize that clinicians are not delivering guideline concordant care, which is putting patients and the public at risk. To test this hypothesis, we will carryout three specific aims: 1) describe clinician adherence to guidelines for the provision of chronic opioid therapy; 2) examine, using survival regression models, the longitudinal association between guideline adherence and patient deaths (all-cause, overdose, and violent); and 3) explore the moderating effects of psychiatric and substance use disorders on this relationship. To accomplish these aims, we will conduct a secondary analysis of data from the Veterans Aging Cohort Study (VACS): an observational, prospective study of HIV+ and HIV- veterans. With this data, we will have access to clinical, administrative, and pharmacy data on a vulnerable patient group for which CNCP, psychiatric illness, and substance use disorders are prevalent. This project has implications for clinician education and training, which federal agencies have identified as a top priority for addressing the country's fastest-growing drug problem, opioid abuse. This research is also aligned with NIDA's recent initiative to support clinical research to protect against opioid abuse and addiction. Finally, this work is consistent with NIDA's mission to address HIV, and co-occurring conditions, in the context of substance abuse.

产品说明：处方阿片类药物，曾经是用于治疗临终癌症疼痛的药物，最近已成为治疗慢性非癌症疼痛（CNCP）的主要药物，这一趋势越来越有争议。支持长期阿片类药物治疗的安全性和有效性的数据有限（即，长期使用阿片类药物），滥用的风险增加， 患有精神疾病和物质使用障碍的患者。尽管存在这些担忧，CNCP的处方继续增加，近年来零售药店销售的大幅增长证明了这一点：从1997年到2006年，美国的阿片类药物处方数量增加了48%，人均用药量增加了368%（根据美国缉毒署的数据，人均74至369毫克）。令人惊讶的是，这些趋势一直是意外过量死亡和处方药成瘾程度前所未有的上升。这些数据强调了临床医生需要遵守循证阿片类药物治疗指南，该指南于1997年首次推出，旨在促进安全有效地使用处方阿片类药物进行CNCP管理。本提案的总体目标是描述临床医生对循证阿片类药物治疗指南的依从性，并检查HIV+和HIV-患者中指南依从性与患者安全性之间的相关性。我们假设临床医生没有提供指南一致的护理，这将使患者和公众处于危险之中。为了验证这个假设，我们将 实现三个具体目标：1）描述临床医生对提供慢性阿片类药物治疗指南的依从性; 2）使用生存回归模型检查指南依从性与患者死亡（全因，过量和暴力）之间的纵向关联; 3）探索精神病和物质使用障碍对这种关系的调节作用。为了实现这些目标，我们将对退伍军人老龄化队列研究（VACS）的数据进行二次分析：这是一项对HIV+和HIV-退伍军人的观察性前瞻性研究。有了这些数据，我们将能够获得CNCP、精神疾病和物质使用障碍普遍存在的弱势患者群体的临床、行政和药房数据。该项目对临床医生教育和培训具有影响，联邦机构已将其确定为解决该国增长最快的毒品问题阿片类药物滥用的首要任务。这项研究也与NIDA最近支持临床研究以防止阿片类药物滥用和成瘾的倡议一致。最后，这项工作符合NIDA的使命，即在药物滥用的情况下解决艾滋病毒和并发症。