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.

抽象的 非洲裔美国人的成年人即使在 控制疼痛严重程度。小儿手术人群的研究更加有限，但 阿片类药物的不同使用模式似乎与成人研究一致。虽然不可能 假设阿片类药物始终是术后疼痛治疗的最佳方法 儿童，由非临床判断驱动的差异使用是令人关注的。但是，这个担心 在阿片类药物成瘾是公共卫生危机的时候存在。虽然大多数青少年 滥用疼痛药物最初是从朋友或家人那里免费接收的， 青少年对处方阿片类药物的访问也有所增加。种族之间的关系 术后疼痛管理和阿片类药物添加的差异很复杂。允许孩子的 由于偏见驱动的担忧，无法接受的痛苦是不可接受的。另一方面， 过度处方可以增加成瘾或将药物转移到非法市场的风险 具有广泛的社会意义。达到正确平衡需要经验证据 支持数据驱动的决策。该建议旨在加强证据基础 关于在手术程序之后的儿童中使用阿片类止痛药，并 通过探索政策，临床需求和社会人口统计学因素的相互关联影响 将医疗补助索赔和电子健康记录数据与全州范围内的发现结合起来 阿片类药物政策清单。这项研究将完成俄亥俄州，该州的阿片类药物排名第五 美国使用来自全国儿童医院的临床数据，该国的死亡率 最大的小儿外科手术提供者，每个小儿手术手术执行超过35,000个 在10个小儿外科专科以及住院和门诊手术的一年 中心。我们将专注于在三个大量小儿外科手术中排出阿片类药物的处方 程序：扁桃体切除术/腺样体切除术，骨上骨折和阑尾切除术。 具体而言，我们的目的是：1）确定种族差异的程度和趋势 自2011年增强阿片类药物处方以来的术后排放阿片类药物处方 减少活动； 2）开发一个扩展的模型，包括疼痛评分和其他EMR 数据，以评估阿片类药物用于小儿术后疼痛和 阿片类药物使用相关的结果。该分析将增强对阿片类药物差异的理解 用于疼痛管理和支持决策的政策和实践，以最大化 疼痛管理中的平等性，同时仍集中于减少滥用和成瘾。