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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.

项目概要/摘要……………………………………………………………………………………………… 这是 Tasce Bongiovanni 博士的 K23 奖项申请，他是一名急症护理、创伤和外科危重症患者加州大学旧金山分校 (UCSF) 的护理医师。 Bongiovanni 博士正在将自己打造为一名研究者以患者为导向，利用实施科学来防止长期使用疼痛老年人术后期间的药物治疗。尽管短期使用阿片类药物可能适合术后疼痛控制，但老年人长期使用可能会导致不良事件包括增加住院和死亡的风险，应该避免。然而，一个转向由阿片类药物流行所驱动的多模式疼痛治疗方案已经出现，但没有注意确保适当停用阿片类药物。由于老年人约占总人口的一半在美国，随着人口迅速老龄化，手术比例预计会增加，了解长期使用不含阿片类药物的药物是一个紧迫的公共卫生问题。这 K23 提案的目标是通过有针对性的、基于证据的干预措施更好地理解和解决老年人术后长期使用止痛药。我的中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治疗，情况变得更糟造成这种现象的主要原因是护理人员之间缺乏沟通和协调团队和患者。该提案的目标是： 1. 在具有全国代表性的医疗保险人群中，定义术后长期使用止痛药的流行病学，包括患者、临床医生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验，以及获取有关解决这些问题的计划试点干预措施的反馈，并 3. 试点干预措施防止老年人手术后长期使用术后止痛药。本次活动的目的制定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策略，以及 4. 职业发展和领导力，专注于老年人手术，长期目标职业目标是将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。 Bongiovanni 博士将主持这项工作与 Steinman 博士领导的 UCSF Pepper 中心的优秀指导团队合作。这项 K23 提案将增进我们对长期使用疼痛的风险因素和驱动因素的了解术后期间的药物治疗，并利用这些知识来设计、完善和测试可行性和防止老年人长期使用干预措施的可接受性。它还将提供先进的研究技能和宝贵的数据开启了 Bongiovanni 博士作为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 R01 提案的基础改善老年人的术后护理。