Effects of VHA opioid policy on prescribing and patient-centered outcomes

VHA 阿片类药物政策对处方和以患者为中心的结果的影响

• 批准号: 9145532
• 负责人: Erin Elizabeth Krebs
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9145532
• 关键词: Acupuncture Therapy; Acupuncture Therapy; Address; Address; Affect; Affect; Attitude; Attitude; Awareness; Awareness; Behavior; Behavior; Caring; Caring; Characteristics; Characteristics; Chronic Disease; Chronic Disease; Clinical; Clinical; Collection; Collection; Complement; Complement; Complementary and alternative medicine; Complementary and alternative medicine; Data; Data; Data Analyses; Data Analyses; Data Collection; Data Collection; Data Reporting; Data Reporting; Data Set; Data Set; Dose; Dose; Effectiveness; Effectiveness; Epidemic; Epidemic; Equilibrium; Equilibrium; Event; Event; Goals; Goals; Health Personnel; Health Personnel; Individual; Individual; Informed Consent; Informed Consent; Knowledge; Knowledge; Longitudinal Surveys; Longitudinal Surveys; Measures; Methods; Methods; Modeling; Modeling; Opioid; Opioid; Opioid Analgesics; Opioid Analgesics; Outcome; Outcome; Overdose; Overdose; Pain; Pain; Pain management; Pain management; Pain quality; Pain quality; Patient Care; Patient Outcomes Assessments; Patient-Focused Outcomes; Patient-Focused Outcomes; Patients; Patients; Perception; Perception; Pharmaceutical Preparations; Pharmaceutical Preparations; Policies; Policies; Population; Population; Primary Health Care; Primary Health Care; Process; Process; Provider; Provider; Public Health; Public Health; Quality of life; Quality of life; Questionnaires; Questionnaires; Reporting; Reporting; Research; Research; Risk Management; Risk Management; Safety; Safety; Sampling; Sampling; Staging; Standardization; Surveys; Surveys; System; System; Telephone; Telephone; Time; Time; Urine; Urine; Veterans; Veterans; Writing; addiction; addiction; chronic pain; chronic pain; chronic pain patient; dashboard; dashboard; drug testing; drug testing; follow-up; follow-up; health administration; health administration; health related quality of life; health related quality of life; high risk; high risk; improved; improved; longitudinal design; longitudinal design; non-opioid analgesic; opioid epidemic; opioid policy; opioid therapy; opioid use; pain model; pain outcome; pain patient; pain rehabilitation; pain rehabilitation; pain relief; patient oriented; patient oriented; patient population; patient population; prescription opioid; prescription opioid; primary outcome; primary outcome; programs; programs; prospective; prospective; response; response; tool; tool; trend; trend

 DESCRIPTION (provided by applicant): Background: Chronic pain is an important public health problem and among the most prevalent and disabling of chronic diseases. After two decades of sustained prescribing increases, opioid analgesics are the most commonly prescribed medications for chronic pain; however, evidence for long-term opioid effectiveness is insufficient. Now, an emerging public health epidemic of opioid-related harms-especially abuse and overdose-has triggered a new era in opioid attitudes and policies, in which opioid prescribing trends are being actively reversed. The Veterans Health Administration (VHA) has been a national leader in pain management-in early initiatives to promote greater awareness of pain, in efforts to expand access to a stepped care model of pain treatment, and in responses to the emerging epidemic of serious opioid-related harms. Recent VHA opioid policies include mandatory written informed consent for long-term opioid therapy and system-wide opioid safety goals to increase use of opioid risk management tools and decrease high-risk prescribing (e.g., high-dose opioid therapy). Because these VHA mandates are being implemented in a larger context of markedly changed attitudes towards opioids and because they are modeled on prior policies that have effectively reduced opioid prescribing, they are anticipated to substantially reduce rates and intensity of opioid prescribing in VHA. If successful, VHA initiatives will reduce potentially hazardous and excessive prescribing of opioids and improve pain and quality of life (QOL) outcomes among Veterans with chronic pain. Objectives: The main objective is to understand patient-centered outcomes of opioid prescribing changes among Veterans treated with opioids for chronic pain. The project will survey a nationally-representative sample of VA primary care patients receiving long-term opioid therapy to collect longitudinal patient-reported pain outcomes data. Specific aims are to examine, among patients receiving long-term opioid therapy, 1) the relationship between changes in opioid daily dose and changes in patient-reported pain and QOL outcomes; and 2) associations of patient, provider, and facility factors with changes in patient-reported pain and health- related QOL, primarily through their influence on opioid daily dose and use of non-pharmacological pain therapies. Methods: Existing data from VHA datasets will be used to identify VA patients prescribed long-term opioids (defined as = 6 consecutive months) for chronic pain. From this population, a nationally representative sample of 13,675 VA primary care patients receiving long-term opioid therapy will be identified using a multi-stage random sampling strategy. Patients included in the sample will be invited to participate in a longitudinal survey and complete brief questionnaires at three time points (baseline, 12 months, and 24 months). Following established methods for maximizing response to mailed surveys, eligible patients will be contacted multiple times by mail for each data collection time point, with a final telephone follow-up for non-responders. Questionnaires will assess pain-related function and health-related QOL as the primary outcomes and will assess pain characteristics, patient perception of treatment, and aspects of the patient-provider relationship as covariates. VHA administrative data will be used to assess patient use of non-pharmacological pain therapies and patient, provider, and facility covariates. Prospective patient-reported survey data will be merged with administrative data for analyses to address the specific aims.

 描述（由申请人提供）： 背景：慢性疼痛是一个重要的公共卫生问题，也是最普遍和最致残的慢性病之一。经过二十年的持续处方增加，阿片类镇痛药是慢性疼痛最常用的处方药;然而，长期阿片类药物有效性的证据不足。现在，阿片类药物相关危害的新公共卫生流行病-特别是滥用和过量-引发了阿片类药物态度和政策的新时代，其中阿片类药物处方趋势正在积极扭转。退伍军人健康管理局（VHA）一直是疼痛管理的国家领导者，在早期的举措，以促进对疼痛的认识，在努力扩大获得疼痛治疗的阶梯式护理模式，并在应对新出现的流行病严重阿片类药物相关的危害。最近的VHA阿片类药物政策包括长期阿片类药物治疗的强制性书面知情同意书和全系统阿片类药物安全目标，以增加阿片类药物风险管理工具的使用并减少高风险处方（例如，高剂量阿片类药物治疗）。由于这些VHA规定是在对阿片类药物的态度发生显著变化的更大背景下实施的，并且由于它们是以有效减少阿片类药物处方的先前政策为模型的，因此预计它们将大幅降低阿片类药物处方的比率和强度 在VHA。如果成功，VHA计划将减少阿片类药物的潜在危险和过度处方，并改善慢性疼痛退伍军人的疼痛和生活质量（QOL）结果。目的：主要目的是了解接受阿片类药物治疗慢性疼痛的退伍军人中阿片类药物处方变化的以患者为中心的结局。该项目将调查接受长期阿片类药物治疗的VA初级保健患者的全国代表性样本，以收集纵向患者报告的疼痛结局数据。具体目的是在接受长期阿片类药物治疗的患者中检查：1）阿片类药物日剂量变化与患者报告的疼痛和QOL结局变化之间的关系; 2）患者、提供者和机构因素与患者报告的疼痛和健康相关QOL变化之间的相关性，主要通过其对阿片类药物日剂量和非药物疼痛治疗的影响。研究方法：VHA数据集的现有数据将用于识别因慢性疼痛接受长期阿片类药物（定义为≥连续6个月）处方的VA患者。从该人群中，将使用多阶段随机抽样策略确定13，675名接受长期阿片类药物治疗的VA初级保健患者的全国代表性样本。样本中的患者将被邀请参加一项纵向研究， 在三个时间点（基线、12个月和24个月）进行调查并完成简要问卷。按照既定的方法，最大限度地提高邮寄调查的响应，将在每个数据收集时间点通过邮件多次联系合格患者， 电话随访无应答者。问卷将评估疼痛相关功能和健康相关QOL作为主要结局，并将评估疼痛特征、患者对治疗的感知以及患者-提供者关系的各个方面作为协变量。VHA管理数据将用于评估患者对非药物疼痛治疗的使用以及患者、提供者和机构协变量。前瞻性患者报告的调查数据将与管理数据合并进行分析，以解决特定目标。