Addressing Opioid Use Disorder in Older Adults through Primary Care Innovation (OUD-PCI)

摘要 医疗研究和质量机构和其他机构正在探索阿片类药物的具体方面 以及初级保健环境中老年人的疼痛管理。65岁以上的人或遭受痛苦的人 远离严重限制他们功能的引起疼痛的条件(例如，身体、精神或心理 阿片类药物不良反应的风险要高得多。这些都是慢性疼痛 个体可能有多种原因，并可能通过多种类型的疼痛表现出来。非癌性慢性疼痛 可能以更复杂的方式与多种健康状况相互作用。药效学和 阿片类药物的药理学在老年人可能会由于生理变化和 多药联用(导致药物之间的相互作用和更多的不良反应)变得更加严重 挑战。此外，同样的患者可能会经历自主性、自我效能感、韧性和 社会支持，而医疗保健系统可能难以有效和安全地协调他们日益增长的 复杂的护理。这些协同风险因素集中在患者和他们的初级保健医生的能力上。 要优化慢性疼痛的管理，需要更精心设计和创新的医疗保健 接近了。目前大多数疼痛管理干预措施都是为典型的年轻患者开发的 可能更频繁地表现出阿片类药物滥用的人群，而可用的方案或资源很少 是为年龄较大或风险较高的成年人量身定做的。这些人更有可能受到 他们在常规临床治疗过程中接受的阿片类药物。因此，解决具体需求和 通过创新和仔细调整现有疼痛管理来应对这些人群的健康挑战 战略是迫切需要的。基于这些考虑，我们团队设计了一个多方面的、人- 俄克拉荷马州初级保健中心将实施可扩展的慢性疼痛管理计划 有系统地为老年人和有功能障碍或社交能力增加的人量身定做的做法 风险。我们的创新方法植根于我们过去开发的最佳实践和资源 学习。我们提议的计划将帮助初级保健实践优化老年人的疼痛管理方法 成人通过综合和跨学科应用先进的多模式疼痛管理， 以疼痛机制为基础的药物治疗、个性化和以目标为导向的护理，侧重于功能性 能力、实施科学、基于证据的质量改进方法和社区参与 设计。

ABSTRACT The Agency for Healthcare Research and Quality and other agencies are exploring specific aspects of opioid and pain management among older adults seen in primary care settings. Those over 65 years old or suffering from conditions that cause pain that significantly limits their functioning (e.g., physical, mental or psychological disabilities) are at considerably higher risk for adverse effects of opioid medications. Chronic pain in these individuals may have multiple causes and can manifest through multiple types of pain. Non-cancer chronic pain may interact with multiple health conditions in a more complex manner. The pharmacodynamics and pharmacology of opioids may be altered significantly at an older age due to physiological changes and polypharmacy (resulting in drug-drug interactions and more adverse effects) becomes a much greater challenge. Furthermore, the same patients may experience decreased autonomy, self-efficacy, resilience, and social support, while the healthcare system may struggle to effectively and safely coordinate their increasingly complex care. These synergistic risk factors converge on the ability of patients and their primary care doctors to optimize the management of chronic pain, requiring more carefully designed and innovative healthcare approaches. Most current pain management interventions have been developed for a typically younger population that may more frequently demonstrate opioid abuse, while few programs or resources are available that are tailored to adults who are older or at higher risk. These individuals are more likely to be harmed by opioids that they receive in the course of regular clinical therapy. Therefore, addressing the specific needs and health challenges of these populations through innovation and careful tailoring of existing pain management strategies is urgently needed. Based on these considerations, our team designed a multi-faceted, person- centered and scalable chronic pain management program to be implemented in Oklahoma primary care practices that is systematically tailored to older adults and those with functional disabilities or increased social risk. Our innovative approach is anchored in best practices and resources that we have developed in past studies. Our proposed initiative will help primary care practices optimize pain management approaches in older adults through an integrated and trans-disciplinary application of advances in multi-modal pain management, pain-mechanism-based pharmacotherapy, personalized and goal-oriented care that focuses on functional capacity, implementation science, evidence-based quality improvement methodology, and community-engaged design.