Improving urine drug test utility to mitigate prescription opioid risk

改善尿液药物测试实用性以降低处方阿片类药物风险

• 批准号: 9882980
• 负责人: Marc Larochelle
• 金额: $ 19.11万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9882980
• 关键词: American; Care given by nurses; Case Manager; Chronic; Classification; Clinical; Clinical Data; Clinical Investigator; Community Health Networks; Complex; Computerized Medical Record; Data; Data Sources; Detection; Development; Effectiveness; Equilibrium; Expert Opinion; Funding; Goals; Guidelines; Health Services Research; Hospitals; Internist; Intervention; K-Series Research Career Programs; Knowledge; Measures; Mentors; Mentorship; Methodology; Methods; Monitor; National Institute of Drug Abuse; Neighborhood Health Center; Observational Study; Opioid; Pain management; Pathway interactions; Patients; Physicians; Primary Health Care; Provider; Quality Indicator; Randomized; Randomized Clinical Trials; Recommendation; Reporting; Research; Research Personnel; Research Project Grants; Resources; Respondent; Risk; Safety; Sales; Sampling; Stream; Surveys; Test Result; Testing; Time; Training; United States National Institutes of Health; Urine; Work; addiction; adjudicate; base; career; chronic pain; clinical data warehouse; clinical database; clinical decision support; clinical practice; cohort; design; dosage; drug metabolism; drug testing; effectiveness testing; electronic data; evidence base; experience; implementation science; improved; multi-component intervention; non-cancer chronic pain; novel; opioid therapy; overdose death; patient oriented; performance tests; point of care; prescription opioid; primary outcome; research and development; response; risk mitigation; safety net; skills; support tools; tool

PROJECT SUMMARY An estimated 100 million Americans suffer from chronic pain, and 5 to 8 million are prescribed chronic opioids for pain management. Overdose deaths due to prescription opioids more than quadrupled between 1999 and 2010, mirroring increases in prescription opioid sales. There is a dearth of evidence-based tools to support providers in the challenging task of balancing potential benefits with known risks of prescription opioid therapy. Guidelines commonly recommend urine drug testing (UDT) as a risk monitoring tool for patients prescribed opioids for chronic non-cancer pain. UDTs can identify misuse or diversion through detection of illicit or non- prescribed controlled substances or absence of prescribed opioids. However, UDTs are challenging to interpret, requiring detailed understanding of complex drug metabolism pathways, and data suggest physicians frequently err in UDT interpretation. Observational studies suggest between 31% and 55% of UDTs are consistent with potential misuse or diversion, but there are scant data on how providers respond to these UDT results. Development of effective risk mitigation strategies for patients prescribed opioids for chronic pain is a key priority for NIH/NIDA. The current proposal seeks to develop and validate a method to identify unexpected UDT results consistent with misuse or diversion using EMR data. We will use this method to characterize the rates of, predictors of, and clinical response to unexpected UDT results in a large cohort of patients receiving chronic opioid therapy. Finally, we will evaluate the acceptability and efficacy of a clinical decision support tool that includes interpretation of UDT results with or without clinical response guidance. Through the Mentored Career Development Award, the candidate will develop skills necessary for transition to an independent research career, including advanced training in research using large clinical databases, training in intervention and implementation science, and development of research-related content and methodological expertise in chronic pain and addiction. The knowledge gained from the proposed scope of work will inform further studies to test the performance of the method to identify unexpected UDT results consistent with misuse or diversion as a quality indicator in a large clinical data research network, and pilot-testing the UDT clinical decision support tool in clinical practice.

项目总结 据估计，有1亿美国人患有慢性疼痛，其中500万至800万人服用了慢性阿片类药物 止痛药。由处方阿片类药物导致的过量死亡人数在1999年至2005年间增加了四倍多 2010年，反映了处方阿片类药物销售的增长。缺乏基于证据的工具来支持 这项具有挑战性的任务是平衡处方阿片类药物治疗的潜在益处和已知风险。 指南通常建议将尿液药物检测(UDT)作为对开出处方的患者进行风险监测的工具 阿片类药物治疗慢性非癌症疼痛。UDT可以通过检测非法或非 规定的受管制物质或没有规定的阿片类药物。然而，UDT正在挑战 解释，需要详细了解复杂的药物代谢途径，数据建议医生 在UDT解释中经常出错。观察性研究表明，31%至55%的UDT 与潜在的误用或转移一致，但关于提供商如何应对这些UDT的数据很少 结果。为慢性疼痛患者处方阿片类药物制定有效的风险缓解策略是一项 NIH/NIDA的关键优先事项。目前的提案寻求开发和验证一种识别意外情况的方法 UDT结果与使用电子病历数据的误用或转移一致。我们将使用此方法来表征 意外UDT的发生率、预测因素和临床反应导致大量患者接受 慢性阿片类药物治疗。最后，我们将评估临床决策支持工具的可接受性和有效性 这包括在有或没有临床反应指导的情况下对UDT结果的解释。通过被指导者 职业发展奖，候选人将发展必要的技能，以过渡到独立 研究生涯，包括利用大型临床数据库进行研究的高级培训、干预培训 和实施科学，以及发展与研究有关的内容和方法专门知识 慢性疼痛和上瘾。从拟议工作范围中获得的知识将为进一步研究提供信息 测试该方法的性能，以确定与误用或转移一致的意外UDT结果 作为大型临床数据研究网络中的质量指标，并试行测试UDT临床决策 临床实践中的支持工具。