Patients with Alcohol Problems and Chronic Pain: Use of Alcohol and Pain Services

描述（由申请人提供）：这是一份由新研究者提出的探索性R21酒精健康服务申请，旨在确定与化学依赖（CD）治疗、非癌症慢性疼痛（CP）治疗的使用相关的个人、提供者、组织和治疗特征，以及大约25,000名患有非癌症慢性疼痛和酒精问题（CPALs）的参保成年人样本中不良事件的发生。在慢性疼痛的研究中，酒精问题经常被忽视；重点通常放在其他物质上。关于它们对CD或CP服务的使用情况，我们知道的就更少了。CPAL对处方阿片类镇痛药的使用以及它如何影响他们对乳糜泻治疗服务的使用也没有进行探讨。传统上，乳糜泻和CP的治疗是分开的，病人可能会从系统的“裂缝”中掉出来。我们建议对北加州Kaiser Permanente （KP）的诊断、利用和药房数据库进行二次分析。我们将确定慢性疼痛患者中酒精问题的患病率，并比较慢性疼痛患者和无酒精问题的慢性疼痛患者（CPwoALs）之间的慢性疼痛治疗和不良事件。我们将评估一个模型，该模型检查了个人、提供者和组织特征在使用CP和CD服务（包括处方阿片类镇痛药的使用）中的作用。最后，我们将研究治疗剂量，除了个人，提供者和组织的特点，是如何与CPALs不良事件的发生相关的。该研究提供了一个独特的机会来研究CPALs对CP和CD治疗服务的利用，利用研究结果来建立CP和CD项目之间的联系，并最终为这些患者制定干预措施。这项研究将有助于评估患者是否正在接受治疗，哪些因素与服务的使用有关，以及治疗是否有助于避免CPALs的不良事件。我们将使用线性和非线性混合模型来调查使用率和不良事件，这将适当地处理提供者之间和设施之间的相关性。研究结果将用于确定酒精问题慢性疼痛患者的护理障碍，并为未来患者结局的研究以及CD和CP治疗的综合模型奠定基础。我们将与临床医生和健康计划合作开展这项未来的研究。

DESCRIPTION (provided by applicant): This is an exploratory R21 alcohol health services application by a new investigator that aims to identify the individual, provider, organizational, and treatment characteristics associated with the utilization of chemical dependency (CD) treatment, non-cancer chronic pain (CP) treatment, and the occurrence of adverse events in a sample of approximately 25,000 insured adults with non-cancer chronic pain and alcohol problems (CPALs). Alcohol problems are often overlooked in research on chronic pain; the focus has usually been on other substances. Even less is known about their utilization of CD or CP services. CPAL's use of prescribed opioid analgesics and how it may influence their use of CD treatment services has also not been explored. CD and CP treatment have traditionally been very separate, and patients may fall through the "cracks" in the system. We propose a secondary analysis of Northern California Kaiser Permanente (KP) diagnostic, utilization, and pharmacy databases. We will identify the prevalence of alcohol problems in chronic pain patients, and compare chronic pain treatment and adverse events between CPALs and chronic pain patients without alcohol problems (CPwoALs). We will assess a model that examines the roles of individual, provider, and organizational characteristics in the use of CP and CD services (including prescribed opioid analgesic use) for CPALs. Finally, we will examine how treatment dose, in addition to individual, provider and organizational characteristics, is related to the occurrence of adverse events for CPALs. The study offers a unique opportunity to study utilization of CP and CD treatment services by CPALs, to use study findings to develop linkages between CP and CD programs, and ultimately to develop an intervention for these paents. This study will help assess whether patients are receiving treatment, what factors relate to use of services, and whether treatment helps to avoid adverse events for CPALs. We will use linear and non-linear mixed models to investigate utilization and adverse events, which will appropriately handle the correlation among providers and among facilities. Study findings will be used to identify barriers to care for chronic pain patients with alcohol problems, and lay the groundwork for future studies of patient outcomes, and integrated models of CD and CP treatment. We will work with clinicians and the health plan to develop this future research.