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

老年人术后长期使用止痛药

基本信息

批准号：
10448743
负责人：
Tasce Riika Simon Bongiovanni
金额：
$ 16.31万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-15 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10448743
关键词：
Address Adopted Adverse drug event Adverse event Age Aging Analgesics Attention Awareness California Capsicum Caregivers Caring Cessation of life Clinical Research Communication Consensus Critical Care Data Drug Prescriptions Elderly Ensure Epidemiology Evidence based intervention Feedback Foundations Fright Goals Guidelines Health system Hospitalization Hospitals Intervention Interview Knowledge Lead Leadership Life Medicare Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methodology Muscle relaxants Operative Surgical Procedures Opioid Pain Pain management Pathway interactions Patients Pattern Pharmaceutical Preparations Physicians Population Postoperative Care Postoperative Pain Postoperative Period Public Health Quality of life Regimen Research Research Personnel Risk Risk Factors San Francisco Site Statistical Data Interpretation Surgeon Testing Time Training Translational Research Trauma United States Universities Work acceptability and feasibility acute care base career career development clinical development comorbidity design experience feasibility testing implementation science implementation strategy improved insight interest multidisciplinary multimodality non-opioid analgesic opioid epidemic opioid sparing patient oriented patient oriented research patient population pharmacokinetics and pharmacodynamics prescription opioid prescription pain reliever prevent skills

项目摘要

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.

项目摘要/摘要………………………… 这是Tasce Bongiovanni博士的K23奖，这是一个急诊，创伤和手术关键的申请加州大学旧金山大学（UCSF）的物理护理。 Bongiovanni博士正在将自己确立为研究人员以患者为导向的研究使用实施科学来防止长时间使用疼痛术后老年人的药物。尽管短期使用阿片类药物的药物可能适合术后疼痛控制，长期在老年人中可以导致广告活动包括增加住院和死亡的风险，应避免。但是，转向阿片类药物流行驱动的多模式疼痛方案已经发生了，而没有注意确保阿片类药物的药物被适当停止。由于老年人约占所有的一半在美国的手术，随着人口迅速衰老的预计，这一比例将增加了解长期使用阿片类药物的药物是紧急的公共卫生问题。这该K23建议的目的是通过针对性的，基于证据的干预措施更好地理解和解决长期使用老年人术后止痛药。我的中心假设是继续术后止痛药在老年人中很常见，随着外科医生向多模式转移而忘记了方案，这种现象在很大程度上是由于护理之间缺乏沟通和协调团队和病人。该提议的目的是：1。在全国代表性的医疗保险人口中，定义长期使用止痛药的流行病学，包括患者，临床和卫生系统风险因素； 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，获取有关计划的飞行员干预以解决这些问题和3的反馈。手术后，防止长期使用术后疼痛药物为老年人使用。这个目的提出的提案是为了直接支持职业发展活动，重点是1。高级统计分析，特别是Medicare数据； 2。强大的定性方法； 3。设计和评估老年人和4的有效实施策略。职业发展和领导，专注于老年人的手术，其长期目标职业目标是结合她的临床和研究改善老年人术后护理和药物使用的兴趣。 Bongiovanni博士将进行此事与斯坦曼博士领导的一支出色的心理团队一起工作，并嵌入了UCSF胡椒中心。该K23提案将提高我们对长期使用疼痛的危险因素和驱动因素的了解术后药物的药物，并利用这些知识来设计，完善和测试可行性和干预措施的可接受性，以防止长期使用老年人。它还将提供高级研究技能和有价值的数据，以启动Bongiovanni博士的职业生涯手术和衰老。数据和培训计划将构成引人注目的R01提案的基础改善老年人的术后护理。