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结局的发生率急剧增加，人们对阿片类镇痛药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，各州老年人的阿片类药物处方率差异很大，从德克萨斯州的2.7%到阿拉斯加的14.5%，从新泽西的11.7%到亚拉巴马的34.8%。我们还发现初级保健医生（PCP）处方II/III类阿片类药物的变异性极高; PCP向非癌症患者处方阿片类药物的百分比范围为0.4%至70.5%。老年患者是否接受阿片类药物的差异中有23%是由患者看到的PCP解释的。阿片类药物处方的这种高度变化-即使在调整患者混合后-也为围绕这一问题的复杂性和混乱提供了重要的见解。在任何一天，医疗服务提供者都面临着治疗严重疼痛患者的艰难决定，必须仔细平衡过度治疗与治疗不足的风险。到目前为止，没有全国性的代表性研究已经检查了老年人使用阿片类药物的变化及其与结果，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.评估阿片类药物使用在提供者之间的变化，并确定与老年人阿片类药物使用相关的患者和提供者因素。3.检查接受阿片类药物的老年患者不良结局的风险，包括福尔斯、骨折、急诊室（ER）就诊、住院、机构化和死亡。我们将使用2007-2015年关于医疗保险受益人的100%国家数据来调查这一不断升级的公共卫生危机。拟议的调查将提供数据， 可以导致公共政策和临床实践指南的改进，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.