Opioid Prescribing and Chronic Pain in the Primary Care Setting

初级保健机构中的阿片类药物处方和慢性疼痛

• 批准号: 10456086
• 负责人: Katherine Elida Warren
• 金额: $ 5.43万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456086
• 关键词: Accounting; Advisory Committees; Affect; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chronic; Clinic; Clinical; Clinical Research; Clinics and Hospitals; Data; Databases; Disease; Dose; Emergency department visit; Environment; Epidemic; Epidemiologic Methods; Epidemiology; Ethnography; Fellowship; Goals; Guidelines; Hospitals; Incidence; Interruption; Intervention; Interview; Investigation; Knowledge; Length; Mediation; Mentors; Methodology; Mission; Morphine; National Institute of Drug Abuse; Neighborhoods; Opioid; Overdose; Pain; Pain management; Patient-Focused Outcomes; Patients; Pattern; Perception; Personal Satisfaction; Persons; Population; Prevalence; Primary Health Care; Professional Organizations; Qualitative Methods; Qualitative Research; Quality of life; Race; Recommendation; Research; Research Methodology; Research Proposals; Risk Behaviors; Safety; Self Perception; Socioeconomic Status; Statistical Methods; Structure; Substance Use Disorder; System; Time; Time Series Analysis; Training; United States; Woman; care outcomes; chronic pain; chronic pain management; chronic pain patient; clinical care; clinical implementation; cohort; ethnographic method; experience; health care service utilization; health disparity; health equity; improved; milligram; multidisciplinary; opioid misuse; opioid overdose; opioid use; opioid use disorder; overdose death; patient safety; prescription opioid; primary care setting; response; safety outcomes; stem; substance use

Project Summary/Abstract Amidst high levels of chronic pain, the United States (U.S.) has seen a concurrent opioid overdose epidemic that has led to the deaths of an estimated 702,000 people between 1999 and 2017. In response to the dramatic rise in opioid-related overdose deaths, a large proportion of interventions have targeted opioid prescribing and pain management. State, federal, and professional organization agencies have implemented changes intended to curb inappropriate opioid prescribing, particularly in the primary-care setting. This includes the release of the CDC Guideline for Prescribing Opioids for Chronic Pain in March 2016, a set of recommendations for primary-care opioid use in pain management. Between 2012 and 2018, U.S. opioid prescribing rates have subsequently fallen by more than one third. These changes have affected the estimated 1.6 million people with opioid use disorder and 50 million people with chronic pain. Concerns about the misapplication of guidelines have arisen, particularly in decisions to reduce or discontinue opioid prescribing among patients with chronic pain. The overall goal of this study is therefore to better characterize the impacts of new opioid prescribing guidelines and associated prescribing patterns for the treatment of chronic pain in the primary-care setting. All three specific aims draw from a hospital-system cohort of primary-care patients with chronic pain who are prescribed chronic opioids. Aim 1 consists of an interrupted time-series analysis to determine the magnitude of changes to opioid prescribing by dose, duration, and prescription type after the implementation of new opioid prescribing guidelines. Aim 2 entails semi-structured interviews with patients with chronic pain to explore the impact of prescribing and pain management changes on quality of life, functioning, pain management, opioid use, healthcare utilization, and perceptions of health equity. Aim 3 involves mediation analysis to determine whether certain patient groups have been disproportionately affected by opioid prescribing changes, particularly by race or socioeconomic status. The proposed research thus aligns with the National Institute on Drug Abuse’s (NIDA) stated goal to better understand the consequences of recent clinical care guideline implementation on opioid prescribing for pain management as well as its mission to support clinical research on substance use and associated disorders. The fellowship training plan includes rigorous methodological training in quantitative epidemiological and clinical ethnographic methods in a vibrant, multidisciplinary training environment. Through training and research, this proposal will help to better characterize the effects of recent efforts to reduce inappropriate opioid prescribing and the associated impacts on patient safety, patient wellbeing, and health equity. Such knowledge has the potential to improve chronic pain care and outcomes, promote responsible opioid prescribing, and lessen health disparities in the primary-care setting.

项目摘要/摘要 在慢性疼痛的高水平中，美国（美国）出现了同时发生的阿片类药物过量流行病 这导致1999年至2017年之间估计有702,000人的死亡。 阿片类药物相关的过量死亡的急剧上升，大量干预措施针对阿片类药物 处方和疼痛管理。州，联邦和专业组织机构已实施 旨在遏制不适当的阿片类药物处方的变化，尤其是在初级护理环境中。这包括 2016年3月，发布了针对慢性疼痛的阿片类药物开制的CDC指南，一组 针对疼痛管理中的初级护理阿片类药物使用的建议。在2012年至2018年之间，美国阿片类药物 处方率随后下跌超过三分之一。这些变化影响了估计的 160万人患有杀菌症和5000万人患有慢性疼痛的人。对此的担忧 出现了误入指南的误解，特别是在减少或停止阿片类药物处方的决定中 在慢性疼痛的患者中。因此，这项研究的总体目标是更好地表征 新的阿片类药物处方指南和相关的处方模式的影响 一级护理环境中的慢性疼痛。这三个具体目标从医院系统组中汲取 处方慢性阿片类药物的慢性疼痛患者。 AIM 1由中断 时间序列分析以确定按剂量，持续时间和持续时间和 实施新的阿片类药物规定指南后的处方类型。 AIM 2实体半结构 对患有慢性疼痛患者的访谈以探索处方和疼痛管理改变的影响 关于生活质量，功能，疼痛管理，阿片类药物的使用，医疗保健利用以及对健康的看法 公平。 AIM 3涉及调解分析，以确定某些患者群体是否已经 不成比例地受到阿片类药物处方变化的影响，特别是受种族或社会经济地位的影响。这 因此，拟议的研究与国家药物滥用研究所（NIDA）一致，提出了更好的目标 了解最近临床护理指南实施对阿片类药物处方的后果 管理及其使命是支持有关药物使用和相关疾病的临床研究。 奖学金培训计划包括在定量流行病学和 在充满活力的多学科培训环境中的临床民族志方法。通过培训和 研究，该建议将有助于更好地描述最近减少不适当的努力的影响 Oopioid处方以及对患者安全，患者健康和健康公平的相关影响。这样的 知识有可能改善慢性疼痛护理和结果，促进负责任的阿片类药物 处方，在主要护理环境中的健康差异较小。