SPOiLER: towards Safer Prescribing of Legal Opioids from the Emergency Room

剧透：在急诊室更安全地开出合法阿片类药物

基本信息

批准号：
10116352
负责人：
William Edward Soares
金额：
$ 18.61万
依托单位：
BAYSTATE MEDICAL CENTER, INC.
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-01 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10116352
关键词：
Accident and Emergency department Acute Applications Grants Attitude Behavior Behavioral Belief Benefits and Risks Characteristics Chronic Clinical Cohort Analysis Data Databases Dependence Development Drug Monitoring Drug Prescriptions Education Emergency Department Physician Emergency Department patient Emergency Situation Epidemic Equilibrium Event Evidence based practice Frequencies Funding Future Goals Grant Harm Reduction Hospitals Individual Interview Leadership Legal Massachusetts Mentors Methods National Institute of Drug Abuse New Hampshire Opioid Outpatients Overdose Pain Patient-Focused Outcomes Patients Physicians Planning Theory Policies Policy Research Probability Provider Qualitative Methods Quasi-experiment Regulation Research Research Personnel Research Project Grants Retrospective cohort Risk Role State Government Statutes and Laws Structure Substance Use Disorder Training United States addiction adverse outcome base behavior change behavioral outcome career development clinically relevant evidence base evidence based guidelines experience health care service utilization implementation trial indexing nonmedical use opioid epidemic opioid policy opioid therapy opioid use opioid use disorder peer pill prescription opioid prevent social norm theories

项目摘要

PROJECT SUMMARY The objective of this NIDA K08 career development proposal is to gain experience and training to become an independent investigator focused on the development of evidence-based practices to prevent and treat substance use disorders in the emergency department. Opioid use disorders, including overdose and addiction, have become epidemic in the United States. While research has largely focused on long-term opioid prescribing in the outpatient setting, emergency department opioid prescribing for acute painful conditions as a portal for future adverse patient outcomes remains poorly defined. State governments, including the Commonwealth of Massachusetts, have reacted to the opioid crisis in part by crafting legislation to broadly limit legal opioid prescriptions. However, opioid medications remain an important treatment option for some acute painful conditions, and evidence based guidance on appropriate prescribing is lacking, in part because the factors that impact providers opioid prescribing behaviors and subsequent patient associated adverse outcomes remains unknown. Understanding the underlying factors that influence opioid prescribing behaviors and future patient outcomes, including state legislation, peer behaviors, hospital attitudes, and local culture, is a critical step in developing integrated, evidence-based recommendations that focus on transforming the culture surrounding safe opioid prescribing practices. Using the theory of planned behavior as a framework, the goals of this K08 grant application are to understand opioid prescribing behaviors and adverse patient outcomes through the following aims: First, we will assess the influence of state legislation, specifically the 2016 Massachusetts (MA) Opioid Law, on the formation of hospital-based regulations and providers' perceived attitudes towards opioid prescribing through qualitative interviews with local physician leaders in MA. Second, using comprehensive claims data, we will evaluate the impact of the 2016 MA Opioid Law on statewide opioid prescribing, using a neighboring state without opioid legislation as a natural control. Finally, we will examine the association of an initial opioid prescription on clinically relevant patient outcomes in order to better understand how restricting opioid prescriptions through legislation may impact emergency department patients presenting with an acute painful condition. From our results, we will create evidence-based recommendations to enhance existing opioid legislation, as well as develop and execute R01 funded comprehensive implementation trials that focus not only on changing behaviors of individual providers, but also transforming the group culture and social norms that influence opioid prescribing behaviors. !

项目摘要这项NIDA K08职业发展建议的目的是获得经验和培训成为专注于开发基于证据的实践的独立调查员，以预防和治疗急诊室中的药物使用障碍。阿片类药物使用障碍，包括过量和成瘾，在美国流行。研究主要集中于长期阿片类药物在门诊环境中开处方，急诊室阿片类药物处方为急性痛苦状况作为未来不良患者预后的门户网站仍然很差。包括马萨诸塞州联邦在内的州政府对阿片类药物危机做出了反应一部分通过制定立法来广泛限制法律阿片类药物处方。但是，阿片类药物仍然是某些急性疼痛状况的重要治疗选择，以及基于证据的指导处方缺乏，部分是因为影响提供者阿片类药物处方行为的因素和随后的患者相关的不良后果仍然未知。了解基础影响阿片类药物处方行为和未来患者结果的因素，包括州立法，同伴行为，医院态度和当地文化是开发综合的，基于证据的关键步骤专注于改变围绕阿片类药物处方实践的文化的建议。将计划行为理论作为框架，本k08授予申请的目标是通过以下目的了解阿片类药物处方行为和不良患者结果：首先，我们将评估州立法的影响，特别是2016年马萨诸塞州（MA）阿片类法律对基于医院的法规和提供者对阿片类药物处方的态度的形成马萨诸塞州当地医师领导人的定性访谈。第二，使用综合索赔数据，我们将使用邻近州评估2016年MA阿片类法律对全州阿片类药物处方的影响没有阿片类药物作为自然控制。最后，我们将检查初始阿片类药物的关联在临床上相关的患者预后处方，以便更好地了解如何限制阿片类药物通过立法的处方可能会影响急诊室患者急性痛苦健康）状况。从我们的结果来看，我们将创建基于证据的建议来增强现有的阿片类药物立法以及制定和执行R01资助的综合实施试验，而不是重点仅在改变单个提供者的行为上，同时也改变了群体文化和社会规范这会影响阿片类药物的处方行为。呢