Assessing the Safety and Effectiveness of Opioid Tapering in Large Health Systems

评估大型卫生系统中阿片类药物逐渐减少的安全性和有效性

• 批准号: 10250728
• 负责人: Ingrid A Binswanger
• 金额: $ 16.32万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10250728
• 关键词: Address; Buprenorphine; COVID-19; COVID-19 pandemic; COVID-19 testing; Caring; Chronic; Clinic; Clinical; Colorado; Data; Dose; Effectiveness; Electronic Health Record; Employment; Epidemiology; Ethnic Origin; Face; Financial Hardship; Gender; Goals; Harm Reduction; Health; Health Services; Health Services Accessibility; Health system; Healthcare; Individual; Information Systems; Interdisciplinary Study; Intervention; Lead; Longitudinal cohort study; Measures; Medicine; Naloxone; Opioid; Opioid Analgesics; Outcome; Overdose; Pain; Pain management; Pathway interactions; Patients; Pattern; Pharmaceutical Preparations; Population; Population Heterogeneity; Positioning Attribute; Primary Health Care; Public Health; Quarantine; Race; Research; Risk; Safety; Services; Social Distance; Social isolation; Sociology; Suboxone; Suspensions; Time; United States; Viral Antibodies; Vulnerable Populations; Wisconsin; Woman; addiction; antibody test; barrier to care; buprenorphine treatment; care delivery; care giving burden; chronic pain; cohort; data infrastructure; ethnic minority population; experience; health disparity; improved; interest; opioid exposure; opioid overdose; opioid tapering; opioid therapy; opioid use disorder; overdose risk; pandemic disease; parent grant; patients who use opioids; prescription opioid; psychological distress; public health emergency; racial minority; study population; substance use; substance use treatment; surveillance data; tool

PROJECT ABSTRACT The United States is confronting two concurrent public health emergencies of opioid overdoses and the coronavirus disease 2019 (COVID-19). The COVID-19 pandemic may contribute to increases in overdose through widespread disruptions of health services, which include services specific to patients with chronic opioid exposure, either prescribed or non-prescribed. Changes to care delivery implemented in health systems including suspension of non-critical services and clinic closures, along with public health measures such as social distancing and quarantine, can create barriers to timely care. Disruptions to care, such as opioid dose variability and discontinuation, may lead to adverse health outcomes, including opioid overdose. These impacts of the pandemic may be unevenly experienced across subpopulations, with potential to reinforce and exacerbate health disparities. The overall goal of this project is to conduct a longitudinal cohort study to examine potential disparate impacts on health and health services in large health systems. Our specific aims: (1) In patients prescribed long-term opioid therapy (LTOT), characterize changes in opioid analgesic and naloxone prescribing patterns, opioid dose variability and discontinuation, primary care utilization, and opioid overdose before and during the COVID-19 pandemic and COVID-19 testing by race/ethnicity and gender; and (2) In patients with opioid use disorder (OUD), characterize changes in buprenorphine treatment for OUD and naloxone prescribing patterns, addiction treatment utilization, and opioid overdose before and during the COVID-19 pandemic and COVID-19 testing by race/ethnicity and gender. We will leverage a data system developed in the parent grant (Pathways to Opioid Safety Datalink [POSD]) that contains data on more than 2.5 million people in Colorado and Wisconsin. We will examine changes in health services in cohorts of patients prescribed chronic opioid therapy and with an opioid use disorder (OUD) before and during the COVID-19 pandemic from 2019 to 2020. Our findings will inform strategies to address under-utilization of appropriate healthcare during the COVID-19 pandemic among vulnerable populations, including improved delivery of care, expanded access to harm reduction measures, and targeted COVID-19 testing.

项目摘要 美国正面临两个并发的阿片类药物过量和 2019冠状病毒病（COVID-19）。COVID-19大流行可能导致过量用药增加 通过卫生服务的广泛中断，其中包括针对慢性病患者的服务， 阿片类药物暴露，无论是处方或非处方。保健系统实施的保健服务改革 包括暂停非关键服务和关闭诊所，沿着采取公共卫生措施， 社交距离和隔离会对及时护理造成障碍。中断护理，如阿片类药物剂量 变异和停药可能导致不良健康结果，包括阿片类药物过量。这些 大流行病的影响在各亚群中可能不均衡，有可能加强和 加剧了健康差距。本项目的总体目标是进行纵向队列研究， 审查对大型卫生系统中的卫生和卫生服务的潜在不同影响。我们的具体目标： (1)在接受长期阿片类药物治疗（LTOT）的患者中，描述阿片类镇痛药的变化， 纳洛酮处方模式、阿片类药物剂量变异性和停药、初级保健利用和阿片类药物 在COVID-19大流行和COVID-19检测之前和期间使用过量药物，按种族/民族和性别分类;以及 (2)在阿片类药物使用障碍（OUD）患者中，描述丁丙诺啡治疗OUD的变化， 纳洛酮处方模式、成瘾治疗利用率和阿片类药物过量 按种族/族裔和性别划分的COVID-19大流行和COVID-19检测。我们将利用数据系统 在母基金中开发的（阿片类药物安全数据链途径[POSD]），包含超过 2.5在科罗拉多和威斯康星州的百万人。我们将在以下人群中研究卫生服务的变化： 患者在治疗前和治疗期间接受慢性阿片类药物治疗并患有阿片类药物使用障碍（OUD）。 二零一九年至二零二零年的COVID-19疫情。我们的研究结果将为解决利用不足问题的战略提供信息。 在2019冠状病毒病大流行期间，为弱势群体提供适当的医疗保健，包括改善 提供护理，扩大减少伤害措施的可及性，以及有针对性的COVID-19检测。