Improving Opioid Prescription Safety After Surgery

提高手术后阿片类药物处方的安全性

• 批准号: 9180573
• 负责人: Karsten Bartels
• 金额: $ 17.83万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9180573
• 关键词: Analgesics; Biometry; Cause of Death; Cesarean section; Cessation of life; Characteristics; Chest; Clinical; Clinical Trials; Cohort Studies; Computerized Medical Record; Consumption; Data; Databases; Dose; Drug abuse; Drug usage; Electronics; Epidemic; Epidemiology; Faculty; Future; Gastrointestinal Surgical Procedures; General Population; Goals; Grant; Hospitals; Inpatients; Knowledge; Medicine; Mentors; Methods; Minor; Modeling; Morbidity - disease rate; Morphine; National Institute of Drug Abuse; Operative Surgical Procedures; Opioid; Outcome; Outpatients; Overdose; Pain; Pain intensity; Pain interference; Pain management; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Postoperative Pain; Postoperative Period; Prevention; Procedures; Reporting; Research; Research Personnel; Research Proposals; Risk Factors; Safety; Sales; Scientist; Source; Survey Methodology; Testing; Thoracic Surgical Procedures; Time; Training; United States; United States National Institutes of Health; addiction; base; career development; design; empowered; health information technology; high risk; improved; medical complication; medical specialties; member; mortality; opioid use; opioid use disorder; patient oriented; pill; prescription drug abuse; prescription opioid; prevent; programs; support tools; tool

Project Summary Over-prescribed opioids after surgery can create a reservoir of opioids that become available for non-medical use. Effective strategies to maximize non-opioid pain therapy and to limit such a reservoir are lacking. Thus, there is an urgent need to study opioid usage patterns and to individualize post-operative pain therapy. The rationale that underlies the proposed research is that once we better understand post-discharge opioid use patterns, we can improve pain management and significantly decrease unnecessarily prescribed opioids. Our central hypothesis is that pain therapy after surgery can be prescribed in an individualized and safer fashion, as opposed to “one size fits all” or non-data driven methods currently employed. To test our hypothesis, three aims are proposed: Specific aim #1 will examine the relationship between patient and procedural characteristics and long-term opioid prescriptions after surgery. This retrospective cohort study includes 6442 patients and will utilize both clinical and claims-based databases. Specific aim #2 will examine patient and procedural characteristics to assess post-operative pain outcomes and predict use patterns for opioids prescribed after surgery. Using survey methods, we will assess pain intensity and interference and quantify consumption of opioids in 600 patients after surgery. A model to predict high vs. low use of prescribed opioids will be developed. Specific aim #3 will prospectively test a decision support tool integrated into the electronic medical record in 116 surgical patients after hospital discharge. The tool will predict actual need for opioid medications and empower patients to maximize non-opioid analgesics. Limiting excess prescription of opioids and maximizing non-opioid medications has the potential to dramatically reduce the amount of opioids available for non-medical use while improving post-operative pain control. The applicant, an anesthesiologist with subspecialty training in pain medicine, proposes a five-year career development program to compliment the research proposal. This incorporates close mentoring by a well-established investigator with expertise in preventing medical complications of drug use in high-risk populations. A mentoring team composed of key faculty members with expertise in psychiatric perspectives of addiction, biostatistics, and health information technology will support the primary mentor. In addition, the candidate has developed a detailed didactic plan that includes training in specialty knowledge in opioid use disorders, epidemiology, health information technology, and clinical trials. The candidate's long-term goal is to develop into an independent clinical scientist with expertise in drug abuse and emphasis on safe and effective delivery of pain therapy after surgery The proposed research, which serves as the key first step towards the applicant reaching his long-term goal, is significant because it will fill the existing gaps in knowledge to curb the United States opioid epidemic and enhance postoperative pain management.

项目摘要 手术后过量处方阿片类药物可以产生阿片类药物的储存库，可用于非医疗用途。 使用.缺乏有效的策略，以最大限度地提高非阿片类药物的疼痛治疗，并限制这样的水库。因此，在本发明中， 迫切需要研究类阿片的使用模式，并使术后疼痛治疗个性化。的 这项研究的基本原理是，一旦我们更好地了解出院后阿片类药物的使用， 模式，我们可以改善疼痛管理，并显着减少不必要的处方阿片类药物。我们 中心假设是，手术后的疼痛治疗可以以个性化和更安全的方式进行， 与当前采用的“一刀切”或非数据驱动的方法相反。为了验证我们的假设， 提出的目标：具体目标#1将检查患者和手术之间的关系 手术后的长期阿片类药物处方。这项回顾性队列研究包括6442例患者， 将同时利用临床和索赔数据库。具体目标#2将检查患者和手术 评估术后疼痛结局和预测术后处方阿片类药物使用模式的特征 手术使用调查方法，我们将评估疼痛强度和干扰，并量化 600例手术后服用阿片类药物。将开发一个模型来预测处方阿片类药物的高与低使用。 具体目标#3将前瞻性地测试集成到电子病历中的决策支持工具， 116例手术患者出院后。该工具将预测阿片类药物的实际需求， 使患者能够最大限度地使用非阿片类镇痛药。限制阿片类药物的过量处方， 非阿片类药物有可能大大减少非医疗用途的阿片类药物的数量 同时改善术后疼痛控制。申请人是一名接受过以下亚专业培训的麻醉师： 疼痛医学，提出了一个五年的职业发展计划，以恭维的研究建议。这 包括由一名在预防医疗事故方面具有专门知识的知名调查员进行密切指导， 在高危人群中使用毒品的并发症。由具有专业知识的主要教师组成的指导团队 在成瘾的精神病学观点中，生物统计学和健康信息技术将支持初级 导师此外，候选人已经制定了详细的教学计划，其中包括专业培训 阿片类药物使用障碍，流行病学，健康信息技术和临床试验的知识。的 候选人的长期目标是发展成为一名独立的临床科学家，具有药物滥用方面的专业知识， 强调手术后疼痛治疗的安全性和有效性这项拟议的研究作为 申请人实现其长期目标的关键第一步，意义重大，因为它将填补现有的 知识的差距，以遏制美国阿片类药物的流行和加强术后疼痛管理。