Prolonged Use of Pain Medication Past the Postoperative Period in Older Adults

项目概要/摘要... 这是Tasce Bongiovanni博士K23奖的申请，他是一名急性护理，创伤和外科危重病人。 加州大学旧金山弗朗西斯科（UCSF）的护理医师。Bongiovanni博士正在建立自己作为 研究人员在以病人为导向的研究使用执行科学，以防止长期使用的疼痛 老年人在术后期间的药物治疗。虽然短期使用阿片类药物 可能适用于术后疼痛控制，老年人长期使用可能导致不良事件 包括增加住院和死亡的风险，应该避免。 但 转向 由阿片类药物流行驱动的多模式疼痛治疗方案已经发生，但没有注意确保 适当停用阿片类药物。 因为老年人大约占了 在美国，随着人口迅速老龄化，这一比例预计将增加， 对长期使用类阿片保留药物的认识是一个紧迫的公共卫生问题。 的 K23提案的目的是通过有针对性的循证干预， 老年人术后长期使用止痛药。我的核心假设是， 术后止痛药在老年人中很常见，随着外科医生转向多模式， 这一现象主要是由于护理人员之间缺乏沟通和协调， 团队和病人。本提案的目的是：1.在具有全国代表性的医疗保险人群中，定义 长期使用术后处方止痛药的流行病学，包括患者、临床医生 卫生系统风险因素; 2。对临床医生和老年患者进行定性访谈， 他们的护理人员记录术后长期使用止痛药的经历， 获得关于计划的试点干预措施的反馈，以解决这些问题; 3.引导干预， 防止老年人手术后长期使用术后止痛药。其目的是 拟订了直接支持职业发展活动的建议，重点是1. 先进的统计分析，特别是医疗保险数据; 2。稳健的定性方法; 3.设计与 评估老年人的有效实施战略; 4.职业发展和领导能力， 专注于老年人的手术，长期目标是将她的临床和研究结合起来 改善老年人术后护理和药物使用的兴趣。邦乔瓦尼医生会负责 与一个特殊的指导团队合作，由斯坦曼博士领导，并嵌入在UCSF胡椒中心。 这项K23提案将促进我们对长期使用疼痛的风险因素和驱动因素的了解。 在术后期间的药物，并使用这些知识来设计，完善和测试的可行性， 干预措施的可接受性，以防止老年人长期使用。它还将提供先进的研究 Bongiovanni博士作为一名独立调查员的职业生涯， 手术和衰老数据和培训计划将共同构成令人信服的R 01提案的基础， 改善老年人术后护理。

Project Summary/Abstract……………………………………………………………………………………………… This is an application for a K23 award for Dr. Tasce Bongiovanni, an acute care, trauma and surgical critical care physician at University of California, San Francisco (UCSF). Dr. Bongiovanni is establishing herself as an investigator in patient-oriented research using implementation science to prevent the prolonged use of pain medications in older adults in the postoperative period. Although short-term use of opioid-sparing medications may be appropriate for postoperative pain control, long-term use in older adults can lead to adverse events including increased risk of hospitalization and death, and should be avoided. However, a shift towards multimodal pain regimens driven by the opioid epidemic has taken place without attention to ensuring that opioid-sparing medications are discontinued appropriately. Since older adults account for roughly half of all surgeries in the United States, a proportion expected to increase as the population rapidly ages, a deeper understanding of prolonged use of opioid-sparing medication is an urgent public health concern. The objective of this K23 proposal is to better understand and address, via a targeted, evidence-based intervention, prolonged used of postoperative pain medication in older adults. My central hypothesis is that continuation of pain medication postoperatively is common in older adults, has worsened as surgeons shift to multimodal regimens, and that this phenomenon is largely due to lack of communication and coordination between care teams and patients. The aims of this proposal are: 1. In a nationally representative Medicare population, define the epidemiology of prolonged use of pain medications prescribed postoperatively, including patient, clinician and health system risk factors; 2. Conduct qualitative interviews with clinicians and older adult patients and their caregivers to document experiences of prolonged use of pain medication in the postoperative period and obtain feedback about a planned pilot intervention to address these issues and 3. Pilot an intervention to prevent the prolonged use of postoperative pain medication for older adults after surgery. The aims of this proposal are developed to directly support career development activities with a focus on training in 1. Advanced statistical analysis, specifically of Medicare data; 2. Robust qualitative methodology; 3. Design and evaluate effective implementation strategies for older adults and 4. Career development and leadership, focused on surgery in older adults, with the long-term goal career goal to combine her clinical and research interests to improve postoperative care and medication use in older adults. Dr. Bongiovanni will conduct this work with an exceptional mentoring team, led by Dr. Steinman and embedded in the UCSF Pepper Center. This K23 proposal will advance our knowledge of the risk factors and drivers of prolonged use of pain medication in the postoperative period, and use this knowledge to design, refine and test the feasibility and acceptability of an intervention to prevent prolonged use for older adults. It will also provide advanced research skills and valuable data to launch Dr. Bongiovanni’s career as an independent investigator at the intersection of surgery and aging. Together, the data and training plan will form the basis for a compelling R01 proposal to improve postoperative care for older adults.