Analgesic safety and effectiveness in older veterans with arthritis

患有关节炎的老年退伍军人的镇痛安全性和有效性

• 批准号: 10016118
• 负责人: Ula Y Hwang
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016118
• 关键词: Address; Adverse event; Age-Years; Aging; Alcohol consumption; Analgesics; Arthritis; Cardiovascular system; Characteristics; Clinic; Clinical; Cohort Studies; Coxibs; Data; Data Collection; Data Set; Degenerative polyarthritis; Diagnosis; Disease; Dose; Effectiveness; Elderly; Evaluation; Event; Fracture; Frequencies; General Population; Geography; Goals; Guidelines; Health; Health behavior; Hepatic; Hip region structure; Hospitalization; Kidney; Knee Osteoarthritis; Link; Longitudinal Studies; Longitudinal cohort; Medicare/Medicaid; Medication Management; Methods; Military Personnel; Non-Steroidal Anti-Inflammatory Agents; Observational Study; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Patients; Pattern; Pharmaceutical Preparations; Population; Predictive Factor; Primary Health Care; Prospective cohort study; Recommendation; Regimen; Research; Research Design; Safety; Severities; Smoking; Surveys; Tobacco use; Trauma; Treatment outcome; United States National Institutes of Health; Veterans; arthritic pain; chronic pain; chronic pain management; chronic pain patient; cognitive function; cohort; comparative; comparative effectiveness study; compare effectiveness; comparison group; evidence base; falls; gastrointestinal; health service use; mortality; patient safety; prospective; recruit; respiratory; safety outcomes; treatment effect; treatment services

DESCRIPTION (provided by applicant): Background: Aging veterans are the largest growing cohort in the VHA population and pain related disorders are the most prevalent of health related conditions. Recent observational studies have raised questions about the safety and effectiveness of conventional analgesic regimens for pain treatment in older adults. In particular, these studies have raised concerns about the safety of opioids versus non-steroidal anti-inflammatory drugs (NSAIDs) of analgesics in older adults, medications commonly prescribed to veterans. Research gaps in optimal older adult pain treatment remain and more evidence-based research is needed before conclusive recommendations and guidelines can be endorsed. Objectives: The objectives of the following proposal are to expand upon the limitations of recent studies by evaluating the safety and effectiveness of 3 commonly used analgesic medications types (opioids, NSAIDs, coxibs) for patients with chronic pain. This will be done with 2 concurrent projects evaluating analgesic use in older veterans diagnosed with arthritis. The first will be a prospective cohort study, the secon will use national administrative data. Specific aims will be to determine: 1. the long-term safety of commonly used analgesic medications in older veterans diagnosed with arthritis, 2. the effectiveness of commonly used analgesic medications in older veterans diagnosed with arthritis, 3. the factors that predict positive and negative analgesic treatment outcomes for this cohort. Methods: To accomplish these objectives we will complete two projects targeting older (50+ years age) veterans with arthritis. The first study will prospectively survey older veterans with arthritis recruited from primary care clinics at four different VA centers with geographic and prescribing pattern diversity. Prospective data collection will allow us to address limitations identified with retrospective data use. These include collecting data on current pain levels, over the counter analgesic use, functional scores (including cognitive function), and health behavior factors (e.g., smoking). The second study use a national cohort of US veterans and replicate a controversial study comparing the safety of analgesics in a cohort of veterans with osteoarthritis. Using a longitudinal cohort of veterans from 2010-2014, the comparative safety of NSAIDs, selective coxibs, and opioids will be determined using both propensity score-matched cohorts and instrumental variable analyses. Veterans Health Administrative data, linked to Medicare and Medicaid claims data, will allow for a robust evaluation of patient safety outcomes.

描述（由申请人提供）： 背景：老化的退伍军人是VHA人群中最大的增长队列，与疼痛有关的疾病是与健康相关的疾病中最普遍的。最近的观察性研究提出了有关传统镇痛治疗方案对老年人疼痛治疗的安全性和有效性的问题。特别是，这些研究引起了人们对阿片类药物与非甾体类抗炎药（NSAIDS）在老年人中的安全性（NSAIDS）的担忧，通常是向退伍军人开的药物。在最佳的老年人疼痛治疗方面的研究差距仍然存在，并且在确定建议和准则之前需要进行更多基于证据的研究。目的：以下提案的目标是通过评估3种常见使用的止痛药类型（阿片类药物，NSAID，Coxibs）的安全性和有效性来扩展最近研究的局限性。这将通过2个并发项目来完成，这些项目评估被诊断为关节炎的老年退伍军人。第一个将是一项前瞻性队列研究，SECON将使用国家行政数据。具体目的是确定：1​​。在诊断为关节炎的老年退伍军人中，常用镇痛药的长期安全性，2。诊断为关节炎的老年退伍军人中常用的镇痛药的有效性，3。方法：为了实现这些目标，我们将完成两个针对具有关节炎的老年人（50岁以上）退伍军人的项目。第一项研究将前瞻性地调查老年退伍军人，该退伍军人是从四个不同的VA中心的初级保健诊所招募的，具有地理和地理和 处方模式多样性。预期数据收集将使我们能够解决回顾性数据使用所识别的限制。其中包括收集有关当前疼痛水平的数据，在反镇痛作用，功能分数（包括认知功能）和健康行为因素（例如吸烟）中。第二项研究使用了美国退伍军人的国家队列，并复制了一项有争议的研究，比较了镇痛药在患有骨关节炎的老兵中的安全性。 从2010- 2014年开始，将使用NSAID，选择性Coxibs和阿片类药物的比较安全性，使用倾向匹配匹配的队列和仪器变量分析确定。与医疗保险和医疗补助索赔数据相关的退伍军人卫生行政数据将允许对患者安全结果进行强有力的评估。