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 长期阿片类药物治疗的患者正在衰老，现在面临着持续高剂量的伤害风险 阿片类药物使用这些增加的风险是由于药物代谢的年龄相关变化，多发病率， 多药疗法缓解这些风险的主要方法是筛查异常患者阿片类药物 行为，与评估，如当前阿片类药物滥用措施（COMM），使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。通过关注 仅阿片类药物滥用，这种策略就会鼓励与阿片类药物过量相关的强制阿片类药物减量 心理健康危机。许多人患有精神健康、创伤相关或多种物质使用障碍 需要解决的问题指导临床医生关注与阿片类药物相关的共病状况 滥用可促进更安全和更有效的护理。这种方法提供了更广泛的理解， 疼痛的经验，并可能有助于解决为什么病人使用或滥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，用于收集临床疼痛数据和评估， 通过电子健康记录预防和管理晚年的疼痛;以及（2）评估 PainTracker的比较有效性，这是一组针对广泛问题的问题， 在一项随机对照试验中，使用电子健康记录、患者门户网站和 患者报告结局功能，我们将为随机实验开发编程逻辑 平台，其中可以向患者递送两个或更多个版本的疼痛调查（目标1）。我们将使用这个 评估PainTracker的系统，交付给一半的样本（2，579名患者）。主要结局是 患者转诊至非阿片类药物治疗的比率（例如，精神和行为健康护理，抗抑郁药处方， 物理治疗和睡眠药物）。次要结局将包括阿片类药物的处方量， 非阿片类止痛药、苯二氮卓类药物和抗抑郁药。假设每种疾病有2,579名患者， 有80%的机会检测到具有25%对29%转诊率的组之间的差异， 假设显著性水平为0.05和双侧检验。每例慢性阿片类药物使用登记研究参与者 符合入选标准的患者将：（i）被分配到涉及患者调查的两种情况之一（疼痛 Tracker + COMM或COMM单独1）;（ii）提示3次完成调查;以及（iii）收到 评分也发送到Epic®中的医生收件箱。这项补充建议是回应以下事项： AG-22-005，寻求“提高对疼痛机制的理解”的应用 经验与老化”。它旨在通过以下方式改善长期接受阿片类药物治疗的疼痛患者的健康状况 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。