Addressing Opioid Use Disorder in Older Adults through Primary Care Innovation (OUD-PCI)

通过初级保健创新解决老年人阿片类药物使用障碍 (OUD-PCI)

• 批准号: 10246916
• 负责人: Steven Alan Crawford
• 金额: $ 82.62万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10246916
• 关键词: Addressing; Opioid; Use; Disorder; Older

ABSTRACT The Agency for Healthcare Research and Quality and other agencies are exploring specific aspects of opioid and pain management among older adults seen in primary care settings. Those over 65 years old or suffering from conditions that cause pain that significantly limits their functioning (e.g., physical, mental or psychological disabilities) are at considerably higher risk for adverse effects of opioid medications. Chronic pain in these individuals may have multiple causes and can manifest through multiple types of pain. Non-cancer chronic pain may interact with multiple health conditions in a more complex manner. The pharmacodynamics and pharmacology of opioids may be altered significantly at an older age due to physiological changes and polypharmacy (resulting in drug-drug interactions and more adverse effects) becomes a much greater challenge. Furthermore, the same patients may experience decreased autonomy, self-efficacy, resilience, and social support, while the healthcare system may struggle to effectively and safely coordinate their increasingly complex care. These synergistic risk factors converge on the ability of patients and their primary care doctors to optimize the management of chronic pain, requiring more carefully designed and innovative healthcare approaches. Most current pain management interventions have been developed for a typically younger population that may more frequently demonstrate opioid abuse, while few programs or resources are available that are tailored to adults who are older or at higher risk. These individuals are more likely to be harmed by opioids that they receive in the course of regular clinical therapy. Therefore, addressing the specific needs and health challenges of these populations through innovation and careful tailoring of existing pain management strategies is urgently needed. Based on these considerations, our team designed a multi-faceted, person- centered and scalable chronic pain management program to be implemented in Oklahoma primary care practices that is systematically tailored to older adults and those with functional disabilities or increased social risk. Our innovative approach is anchored in best practices and resources that we have developed in past studies. Our proposed initiative will help primary care practices optimize pain management approaches in older adults through an integrated and trans-disciplinary application of advances in multi-modal pain management, pain-mechanism-based pharmacotherapy, personalized and goal-oriented care that focuses on functional capacity, implementation science, evidence-based quality improvement methodology, and community-engaged design.

摘要 医疗保健研究和质量机构以及其他机构正在探索阿片类药物的具体方面。 和疼痛管理在老年人中看到在初级保健设置。65岁以上或患有 从引起显著限制其功能的疼痛的状况（例如，身体上的，精神上的，心理上的 残疾人）对阿片类药物的不良反应风险相当高。慢性疼痛在这些 个人可能有多种原因，并可能通过多种类型的疼痛表现出来。非癌性慢性疼痛 可能以更复杂的方式与多种健康状况相互作用。的药效学和 阿片类药物的药理学可能在老年时由于生理变化而显著改变， 多药治疗（导致药物相互作用和更多的不良反应）变得更加重要。 挑战.此外，同样的患者可能会经历自主性，自我效能感，弹性下降， 社会支持，而医疗保健系统可能难以有效和安全地协调他们越来越多的 复杂的护理。这些协同作用的风险因素汇聚在患者和他们的初级保健医生的能力 优化慢性疼痛的管理，需要更精心设计和创新的医疗保健 接近。目前大多数疼痛管理干预措施都是为典型的年轻人开发的。 可能更频繁地表现出阿片类药物滥用的人群，而可用的计划或资源很少 专门针对年龄较大或风险较高的成年人。这些人更有可能受到伤害， 他们在常规临床治疗过程中接受的阿片类药物。因此，解决具体需求和 通过创新和精心定制现有的疼痛管理， 迫切需要战略。基于这些考虑，我们的团队设计了一个多方面的，人- 在俄克拉荷马州初级保健中实施一项集中和可扩展的慢性疼痛管理计划 有系统地针对老年人和有功能性残疾或社交能力增强的人制定的做法 风险我们的创新方法立足于我们过去开发的最佳实践和资源 问题研究我们提出的倡议将有助于初级保健实践优化老年人的疼痛管理方法 成人通过综合和跨学科的应用，在多模式疼痛管理的进展， 疼痛机制为基础的药物治疗，个性化和目标导向的护理，重点是功能 能力、实施科学、基于证据的质量改进方法和社区参与 设计