Pattern, Variation and Outcomes of Opioid Prescription in Older Adults

 描述(由申请人提供)：鉴于阿片类药物处方增加了三倍，阿片类药物相关不良后果的发生率急剧增加，人们对阿片类止痛剂治疗慢性非癌症疼痛的安全性和有效性提出了担忧。我们的初步数据显示，各州为老年人开出阿片类药物的比例差异很大，从德克萨斯州的2.7%到阿拉斯加的14.5%，附表III从新泽西州的11.7%到阿拉巴马州的34.8%。我们还发现，初级保健医生(PCP)在开出附表II/III阿片类药物方面存在极高的变异性；给非癌症患者开阿片类药物的PCP比例从0.4%到70.5%不等。老年患者是否接受阿片类药物治疗的差异中，23%是通过患者看到的PCP来解释的。阿片类药物处方的如此高的差异--即使在对患者组合进行调整之后--提供了对围绕这一问题的复杂性和混乱的关键洞察。在任何一天，医疗提供者都面临着治疗患有严重疼痛的患者的艰难决定，必须仔细权衡过度治疗和治疗不足的风险。到目前为止，还没有全国性的代表性研究考察老年人使用阿片类药物的差异及其与结果、不同的州法规和联邦政策的关系。我们的具体目标是：1.检查老年人阿片类药物使用的流行率、持续时间和剂量的时间变化，特别关注政策变化的影响。2.评估不同提供者之间阿片类药物使用的差异，并确定与老年人使用阿片类药物有关的患者和提供者因素。3.检查接受阿片类药物治疗的老年患者的不良后果风险--包括跌倒、骨折、急诊室就诊、住院、住院和死亡。我们将使用2007-2015年100%的全国医疗保险受益人数据来调查这场不断升级的公共卫生危机。拟议的调查将提供以下数据 可以改进公共政策和临床实践指南，以确保老年人安全有效地使用阿片类药物。

 DESCRIPTION (provided by applicant): Concerns have been raised about the safety and effectiveness of opioid analgesics for chronic non-cancer pain in view of a threefold increase in opioid prescribing and a dramatic increase in the rates of opioid-related adverse outcomes. Our preliminary data showed the rate of opioid prescriptions for older adults varied dramatically across states, from 2.7% in Texas to 14.5% in Alaska for schedule II and from 11.7% in New Jersey to 34.8% in Alabama for schedule III. We also found exceedingly high variability in prescribing schedule II/III opioids among primary care physicians (PCPs); the percentage of PCPs prescribing opioids to their non-cancer patients ranged from 0.4% to 70.5%. Twenty-three percent of the variance in whether an elderly patient received an opioid was explained by which PCP the patient saw. Such high variation in opioid prescribing-even after adjustment for patient mix-offers critical insight into the complexity and confusion surrounding this issue. On any given day, providers-faced with difficult decisions about treating patients with severe pain-must carefully balance the risks of overtreatment versus undertreatment. To date, no nationally representative studies have examined variations in the use of opioids in older adults and their relationship to outcomes, different state regulations, and federal policy. Our Specific Aims are: 1. Examine temporal changes in the prevalence, duration, and dose of opioid use in older adults, with particular focus on the impact of policy changes. 2. Assess the variation of opioid use across providers and determine patient and provider factors associated with opioid use in older adults. 3. Examine the risk of adverse outcomes-including falls, fractures, emergency room (ER) visits, hospitalization, institutionalization, and mortality-in older patients receiving opioids. We will use 2007-2015 100% national data on Medicare beneficiaries to investigate this escalating public health crisis. The proposed investigation will provide data that can lead to improvements in public policy and clinical practice guidelines for ensuring safe and effective use of opioids in older adults.