Guiding Aging Long-Term Opioid Therapy Users Into Safer Use Patterns

指导老年长期阿片类药物治疗使用者养成更安全的使用模式

• 批准号: 10615508
• 负责人: JASON N. DOCTOR
• 金额: $ 43.27万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10615508
• 关键词: Address; Age-Years; Aging; Agreement; Antidepressive Agents; Attention; Automobile Driving; Behavior; Benzodiazepines; Caring; Chronic; Collaborations; Collection; Data; Disease; Dose; Elderly; Electronic Health Record; Face; Health; Health system; Healthcare; ImProv; Impairment; Lead; Life; Logic; Measures; Medicine; Mental Health; Midwestern United States; Opioid; Pain; Pain Measurement; Pain management; Participant; Pathway interactions; Patient Care; Patient Outcomes Assessments; Patients; Pattern; Persons; Physical therapy; Physicians; Polypharmacy; Primary Health Care; Randomized; Randomized Controlled Trials; Registries; Research Personnel; Risk; Sample Size; Sampling; Side; Sleep; Stigmatization; Surveys; System; Testing; Time; Trauma; Universities; Visit; age related; behavioral health; clinical pain; comorbidity; comparative effectiveness; dosage; drug metabolism; experience; improved; improved functioning; inclusion criteria; multiple chronic conditions; non-opioid analgesic; opioid misuse; opioid overdose; opioid tapering; opioid therapy; opioid use; parent grant; patient portal; patient screening; polysubstance use; pragmatic trial; preempt; prevent; primary outcome; randomized trial; response; screening; secondary outcome; skill acquisition; stressor; tool

ABSTRACT Patients on long-term opioid therapy are aging and now face magnified risk of harm with continued high-dose opioid use. These increased risks are due to age-related changes in drug metabolism, multi-morbidity, and polypharmacy. The dominant approach to mitigate these risks is to screen for aberrant patient opioid behaviors, with assessments like the Current Opioid Misuse Measure (COMM), so that clinicians can pre-empt misuse early through review of contractual opioid agreements or by lowering patient dosages. By focusing on opioid misuse alone, this strategy encourages forced opioid tapering that is associated with opioid overdose and mental health crisis. Many persons have mental health, trauma-related or polysubstance use disorders that need to be addressed. Directing clinician attention to the comorbid conditions associated with opioid misuse may promote safer and more effective care. Such an approach provides a broader understanding of the pain experience and may help address the reasons why patients use or misuse opioids. The specific aims are: (1) to develop a simple experimental approach for the collection of clinical pain data and for assessing, preventing, and managing pain in later life through the electronic health record; and (2) to assess the comparative effectiveness of PainTracker, a set of questions that targets a broad range of problems associated with pain, in a randomized controlled trial. Using the electronic health record, patient portal, and patient-reported outcome capabilities, we will develop programming logic for a randomized experimentation platform wherein two or more versions of pain surveys may be delivered to patients (Aim 1). We will use this system to evaluate PainTracker, delivered to half of the sample (2,579 patients). The primary outcome is patient referral rate to non-opioid care (e.g., mental and behavioral health care, antidepressant prescribing, physical therapy, and sleep medicine). Secondary outcomes will include prescription quantities for opioids, non-opioid pain medications, benzodiazepines and antidepressants. Assuming 2,579 patients per condition, there is an 80% chance to detect differences between groups that have a 25% vs 29% referral rate, assuming a significance level of 0.05 and a two-sided test. Each Chronic Opioid Use Registry participant that meets the inclusion criteria will: (i) be assigned to one of two conditions involving patient surveys (Pain Tracker + COMM or COMM alone1); (ii) be prompted 3 times to complete the survey; and (iii) receive a score also delivered to their physician's inbox in Epic®. This supplemental proposal is in response to NOT- AG-22-005 which seeks applications that "improv[e] the understanding of mechanisms underlying pain experience with aging". It aims to improve the health of persons with pain on long-term opioid therapy by identifying appropriate assessments to better address their pain experience and problems in their lives.

摘要 长期接受阿片类药物治疗的患者正在老龄化，现在持续大剂量服用阿片类药物将面临更大的伤害风险。 阿片类药物的使用。这些增加的风险是由于与年龄相关的药物代谢变化、多种发病率和 综合药房。减轻这些风险的主要方法是筛查异常的患者阿片类药物。 行为，与目前的阿片滥用测量(COMM)一样的评估，以便临床医生可以先发制人 通过审查合同阿片类药物协议或降低患者剂量来早期滥用。通过专注于 阿片类药物滥用本身，这一策略鼓励强制减少与阿片类药物过量有关的阿片类药物 和心理健康危机。许多人有精神健康、创伤相关或多物质使用障碍。 这一点需要得到解决。引导临床医生注意与阿片类药物相关的共病情况 滥用可能会促进更安全和更有效的护理。这样的方法提供了更广泛的理解 疼痛体验，并可能有助于解决患者使用或误用阿片类药物的原因。具体目标 是：(1)开发一种简单的实验方法来收集临床疼痛数据并进行评估， 通过电子健康记录预防和管理晚年生活中的疼痛；以及(2)评估 PainTracker的相对有效性，这是一组针对广泛相关问题的问题 在一项随机对照试验中，用疼痛治疗。使用电子健康记录、患者门户和 患者报告结果的能力，我们将为随机试验开发编程逻辑 可向患者提供两个或多个版本的疼痛调查的平台(目标1)。我们将使用这个 系统评估PainTracker，交付给一半的样本(2579名患者)。主要结果是 患者转诊至非阿片类药物护理的比率(例如，精神和行为保健、抗抑郁药物处方、 理疗和安眠药)。次要结果将包括阿片类药物的处方数量， 非阿片类止痛药、苯二氮卓类药物和抗抑郁药。假设每种情况下有2579名患者， 有80%的机会发现转介率为25%对29%的群体之间的差异， 假设显着性水平为0.05，进行双侧检验。每位慢性阿片类药物使用登记处参与者 符合纳入标准的患者将：(I)被分配到涉及患者调查(疼痛)的两种情况之一 追踪器+通信或单独通信1)；(Ii)被提示3次以完成调查；以及(Iii)收到 Score还被发送到他们在Epic®的医生收件箱。这项补充建议是为了回应不- AG-22-005，该文件寻求应用程序来提高对潜在疼痛机制的理解 与衰老相关的经验“。它的目的是改善长期接受阿片类药物治疗的疼痛患者的健康，方法是 确定适当的评估，以更好地解决他们的痛苦经历和生活中的问题。