Providers and Older Pain Patients with Prescription Opioid Dependence: A Qualitative Study to Understand Barriers to Opioid Taper, Cessation, and Transition to Buprenorphine.

项目摘要 在CDC的阿片类药物处方指南发布后， 处方阿片类镇痛药使用（非统组织）。然而，是否以及如何逐渐减少，停止处方，或过渡到 丁丙诺啡用于老年患者（≥50岁）尚不清楚。许多老年患者已成为慢性处方阿片类药物 用户.阿片类药物研究的思想领袖同意，缺乏针对老年患者的研究， 这阻碍了临床科学和干预措施。我们不知道对病人或提供者信念的研究 关于阿片类药物停用、减量或过渡到丁丙诺啡，这是老年患者特有的。虽然这两 患者和医疗服务提供者认识到依赖风险， 慢性非统组织，如突发心脏病，新发和恶化的抑郁症，痛觉过敏 雄激素缺乏以及与奖赏相关的大脑区域的变化则不太为人所知。老年人是 也不太可能意识到与代谢变化能力降低相关的致死性过量的可能性， 与年龄相关的认知障碍和其他与衰老相关的因素。因此，即使老年患者不 滥用，慢性非统组织的健康后果和缺乏证据的疗效慢性非统组织 应导致患者-提供者讨论逐渐减少、停止和可能过渡到丁丙诺啡。这 R21提案将利用定性方法来获得较老的慢性非统组织的新的和基本的措施 患者及其提供者感知的逐渐减少、过渡到丁丙诺啡和阿片类药物的障碍和促进因素 停止这将为随后的干预赠款奠定基础。具体目标将：1） 确定老年人中阿片类药物减量、停止和/或开始丁丙诺啡的障碍和促进因素 在一个大型的研究中，来自不同初级保健实践的患有>1年非癌性疼痛的非统组织患者（50岁以上） 中西部卫生系统; 2）确定初级保健提供者所经历的障碍和促进因素， 不同的初级保健实践，无论是否有在阿片类药物减量中开具丁丙诺啡的经验， 在患有>1年的非非统组织非统组织的老年患者（50-75岁）中停止或开始丁丙诺啡治疗， 癌症疼痛，以及3）比较和对比患者和提供者对目标中的障碍和促进者的观点 1和2，以阐明治疗目标是一致的和不一致的，通过采访病人提供者的二人组。 我们研究的新发现将用于后续的干预措施， 后续R 01。我们的长期目标是为老年患者及其提供者提供一种干预措施， 护理环境，以减少或停止多年，连续的非统组织。

Project Abstract Following the release of the CDC’s opioid prescribing guidelines, there has been a decrease in new prescription opioid analgesic use (OAU). Yet, whether and how to taper, stop prescribing, or transition to buprenorphine for older patients (≥50) is unclear. Many older patients have become chronic prescription opioid users. Thought leaders in opioid research agree that there is a dearth of studies specific to older patients, and that this hinders clinical science and interventions. We are unaware of studies of patient or provider beliefs regarding opioid cessation, taper, or transition to buprenorphine that are specific to older patients. While both patients and providers recognize dependence risk, the numerous other adverse health outcomes associated with chronic OAU, such as incident heart disease, new onset and worsening depression, hyperalgesia androgen deficiency, and changes in brain areas associated with reward, are less well known. Older adults are also unlikely to be aware of the potential for fatal overdose related to decreased ability to metabolic changes, age-related cognitive impairment and other factors associated with aging. Thus, even if older patients are not misusing, the health consequences of chronic OAU and lack of evidence for the efficacy of chronic OAU should lead to patient-provider discussions of taper, cessation, and possible transition to buprenorphine. This R21 proposal will utilize qualitative methods to obtain novel and foundational measures of older, chronic OAU patients’ and their providers’ perceived barriers and facilitators to taper, transition to buprenorphine and opioid cessation. This will lay the foundation for a subsequent intervention-oriented grant. Specific aims will: 1) determine barriers and facilitators to opioid taper, cessation and/or initiating buprenorphine among older patients (50+ year) with >1 year of OAU for non-cancer pain from diverse primary care practices in a large Midwestern health system; 2) determine barriers and facilitators experienced by primary care providers from diverse primary care practices, both with and without experience prescribing buprenorphine in opioid tapering, cessation or initiating buprenorphine among older patients (50-75 years old) with >1 year of OAU for non- cancer pain, and 3) compare and contrast patient and provider perspectives of barriers and facilitators in Aims 1 and 2 to elucidate where treatment goals are aligned and misaligned, by interviewing patient-provider dyads. The novel findings from our study will be used in a subsequent intervention to be developed and trialed in a follow-up R01. Our long-term goal is to provide an intervention for older patients and their providers in primary care settings to reduce or stop multi-year, continuous OAU.