Reframing Optimal Management of Pain and Opioids in Older Adults

项目摘要。 老年人中自我报告的疼痛患病率每年增加2-3% 在最近几十年里。安全地开出阿片类药物或替代药物治疗老年疼痛需要 考虑多种药物、认知和身体功能、照顾者、社会支持 服务和报废首选项。实践改进的努力很少被定向 在初级保健(PC)实践中，老年患者占很大比例，因此大多数老年人 成年人没有得到适当的风险评估，包括阿片类药物使用障碍(OUD)。这个 提出的项目，在老年人中安全地管理疼痛，是 密歇根大学(UM)和Altarum，在实施Pain方面带来了广泛的专业知识 通过使用证据的多方面方法改进管理实践- 以处方为基础的教育、学术细节、持续反馈、实践管理 和处方支持，以及利用电子健康记录(EHR)技术。这个 UM和Altarum是领导卫生与公众服务的合作伙伴关系的第三年， 少数民族健康办公室资助的预防和减少阿片类药物相关发病率和 死亡率(底特律阿片类药物预防协作)，使用像我们这样的干预策略 为该项目提出建议。我们的老年人安全管理疼痛项目结合了 Altarum在使用数百个PC实践进行质量改进和 提供者和患者教育计划，以及他们在以下方面的国家认可的专业知识 老年护理，UM的专业知识实施循证疼痛管理和 预防和治疗OUD--特别是筛查、阿片类药物逐渐减少和提供 药物辅助治疗(MAT)。根据AHRQ的使命，我们渴望 实施、研究和传播提供更安全和更公平的服务的方法 为老年人提供疼痛管理护理。

Project Summary. The prevalence of self-reported pain among older adults has increased 2-3 percent annually in recent decades. Safely prescribing opioids or alternatives for geriatric pain requires consideration of polypharmacy, cognitive and physical function, caregivers, social supportive services, and end-of-life preferences. Practice improvement efforts have rarely been directed at primary care (PC) practices with a large proportion of geriatric patients, so most older adults do not receive a proper risk assessment, including for opioid use disorder (OUD). The proposed project, Managing Pain Safely in Older Adults, is a partnership between the University of Michigan (UM) and Altarum, bringing extensive expertise in implementing pain management practice improvements through multi-faceted approaches using evidence- based prescriber education, academic detailing, ongoing feedback, practice management and prescriber support, as well as leveraging electronic health record (EHR) technology. The UM and Altarum are in the third year of a partnership leading a Health and Human Services, Office of Minority Health-funded program to prevent and reduce opioid-related morbidity and mortality (Detroit Opioid Prevention Collaborative), using intervention strategies like those we propose for this project. Our Managing Pain Safely in Older Adults project combines Altarum’s expertise in engaging hundreds of PC practices in quality improvement and provider and patient education programs, along with their nationally recognized expertise in eldercare, with UM’s expertise implementing evidence-based pain management and prevention and treatment of OUD—specifically screening, opioid tapers, and provision of medication assisted treatment (MAT). In alignment with AHRQ’s mission, we aspire to implement, study, and disseminate methods by which to provide safer and more equitable pain management care to older adults.