Opioid prescribing disparities in a public health crisis: The case of pediatric post-surgical pain management

公共卫生危机中阿片类药物处方的差异：儿科术后疼痛管理案例

• 批准号: 9389281
• 负责人: Deena Chisolm
• 金额: $ 18.94万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9389281
• 关键词: Accident and Emergency department; Adenoidectomy; Adolescent; Adult; African American; Age; Ambulatory Surgical Procedures; Analgesics; Appendectomy; Area; Automobile Driving; Caring; Child; Childhood; Clinical; Clinical Data; Complex; Computerized Medical Record; Data; Decision Making; Demographic Factors; Electronic Health Record; Employee Strikes; Epidemic; Equilibrium; Equipment and supply inventories; Family member; Fracture; Friends; Health Policy; Health Services Accessibility; Heroin; Humeral Fractures; Inpatients; Judgment; Link; Medicaid; Minority; Modeling; Ohio; Operative Surgical Procedures; Opiate Addiction; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Patients; Pattern; Pediatric Hospitals; Pediatric Surgical Procedures; Pharmaceutical Preparations; Pharmacy facility; Policies; Policy Making; Population; Postoperative Pain; Postoperative Period; Procedures; Provider; Public Health; Reporting; Research; Risk; Severities; Time; Tonsillectomy; addiction; evidence base; experience; health disparity; implicit bias; innovation; mortality; nonmedical use; opioid use; overdose death; patient population; prescription opioid; prescription pain reliever; public health relevance; racial disparity; trend

Abstract African Americans adults are less likely to receive analgesics, particularly opioids, even after controlling for pain severity. Research in the pediatric surgical population is more limited but the pattern of disparate use of opioids appear consistent with adult research. While it cannot be assumed that opioids are always the best approach to post-operative pain treatment for children, differential use driven by non-clinical judgments is of concern. This concern, however, exists at a time when opioid addiction is a public health crisis. Although most adolescents who misuse pain medications initially receive them for free from a friend or family member, adolescent access to prescribed opioids has also increased. The relationship between racial disparities in postoperative pain management and opioid addition is complex. Allowing a child's pain to go unaddressed because of concerns driven by bias is unacceptable. On the other hand, overprescribing can enhance risk for addiction or diversion of medications to the illicit market with broad societal implications. Striking the right balance requires empirical evidence that supports data-driven decision-making. This proposal aims to strengthen the evidence base regarding use of opioid pain medications in children following surgical procedures and to explore the inter-related impacts of policy, clinical need, and socio-demographic factors by combining Medicaid claims and electronic health record data with findings from a statewide opioid policy inventory. This research will be done Ohio, a state with the 5th highest opioid mortality in the nation using clinical data from Nationwide Children's Hospital, the nation's largest pediatric surgical provider, performing over 35,000 pediatric surgical procedures each year across 10 pediatric surgical subspecialties and both in-patient and ambulatory surgery centers. We will focus on discharge prescribing of opioids in three high volume pediatric surgical procedures: tonsillectomy/adenoidectomy, supracondylar fracture, and appendectomy. Specifically, we aim to: 1) Determine the extent of and trends in racial disparities in postoperative discharge opioid prescribing since the 2011 onset of enhanced opioid prescription reduction activities; and 2) Develop an expanded model, including pain scores and other EMR data, to assess the linkage between differential opioid use for pediatric postoperative pain and opioid use-related outcomes. This analysis will enhance understanding of disparities in opioid use for pain management and support decision making for policy and practice that maximizes equity in pain management while remaining focused on reducing misuse and addiction.

摘要 非裔美国成年人不太可能接受止痛药，特别是阿片类药物，即使在 控制疼痛的严重程度。对儿科外科人群的研究更有限，但 阿片类药物的不同使用模式似乎与成人研究一致。虽然它不可能是 假设阿片类药物始终是治疗术后疼痛的最佳方法 儿童，由非临床判断驱动的差异使用是令人担忧的。然而，这种担忧， 存在于阿片成瘾成为公共健康危机的时候。尽管大多数青少年 滥用止痛药最初是从朋友或家人那里免费获得的， 青少年获得处方阿片类药物的机会也有所增加。种族之间的关系 术后疼痛管理和阿片类药物添加的差异是复杂的。允许一个孩子的 由于偏见驱动的担忧而得不到解决的痛苦是不可接受的。另一方面， 过度开药会增加上瘾或将药物转移到非法市场的风险 具有广泛的社会影响。要取得正确的平衡，需要有经验证据证明 支持数据驱动的决策制定。这项建议旨在加强证据基础。 关于手术后儿童使用阿片类止痛药的情况，并 通过以下方式探索政策、临床需求和社会人口因素的相互关联影响 将医疗补助申请和电子健康记录数据与全州范围内的调查结果结合起来 阿片类药物政策清单。这项研究将在俄亥俄州进行，俄亥俄州是阿片类药物第五高的州 使用全国儿童医院的临床数据计算全国死亡率 最大的儿科外科提供商，每家提供超过35,000例儿科外科手术 年涵盖10个儿科外科亚专科以及住院和门诊外科 中锋。我们将重点介绍三大容量儿科手术中阿片类药物的出院处方 手术方式：扁桃体切除/腺样体切除、髁上骨折和阑尾切除。 具体地说，我们的目标是：1)确定#年种族差距的程度和趋势 2011年起术后出院阿片类药物处方改进 减少活动；和2)开发扩展模型，包括疼痛评分和其他EMR 数据，以评估儿童术后疼痛的不同阿片类药物使用与 与阿片类药物使用相关的结果。这一分析将加强对阿片类药物差异的理解。 用于疼痛管理和政策和实践的支持决策，从而最大限度地 公平的疼痛管理，同时仍然专注于减少滥用和成瘾。