Strategies for Improving Prescription Opioid Use in Perioperative Pain Management

项目摘要 越来越多的处方阿片类药物用于疼痛控制，导致了全国公共卫生 危机。在外科环境中，协调不良的疼痛管理会导致在以下情况下过量开阿片类药物 外科手术，它颁布了阿片类药物转移、滥用和依赖的门户。慢性阻塞性肺病患者 手术前阿片类药物具有特殊的风险，因为手术后需要更高剂量的阿片类药物才能达到 有足够的疼痛控制。然而，几乎没有循证的方法可用于管理患者的疼痛。 关于慢性阿片类药物治疗，特别是对那些术后疼痛的人。为了解决这一差距，我们开发了一种 围术期疼痛计划(PPP)协调手术患者使用慢性阿片类药物的连续护理 在整个围手术期进行治疗。一个多学科团队，包括急性和慢性疼痛 在成瘾医学方面有专长的专家和精神病学家，通过术前与患者合作 会诊、术后住院、术后门诊随访发展 个性化的多模式疼痛管理计划和治疗潜在的精神、行为和 心理并存。在拟议的项目中，我们将评估以下项目的实施和成效 购买力平价。为了评估实现，我们将采用一种具有收敛并行的混合方法方法。 设计。将使用不同的方法收集和三角测量定量和定性数据(图表 评论、观察、采访)。为了评估效果，我们将采用准实验 中断的时间序列设计，比较阿片类药物处方和患者自我报告的结果(例如，疼痛， 功能性)在参与PPP的患者和对照组之间。此外，我们将改编一个 提高患者在PPP中参与度的教育计划。将进行务实的随机试验，以 评估调整后的计划对患者参与度、阿片类药物处方和其他患者自我评估的影响 报告结果。这个项目的重点是处方阿片类药物在围手术期疼痛管理中的使用，这是 这是一个严重的公共卫生问题，具有重大后果和代价。它将为以下方面提供经验证据 PPP在预防处方阿片类药物滥用和改善预后方面的有效性 手术患者，这可以为未来改善药物使用和安全性的努力提供信息。

PROJET SUMMARY Increased utilization of prescription opioids for pain management has led to a nationwide public health crisis. In surgical settings, poorly coordinated pain management causes excessive opioid prescribing after surgery, which promulgates a gateway for opioid diversion, misuse, and dependency. Patients on chronic opioids before surgery present a special risk because they require higher opioid doses after surgery to achieve adequate pain control. However, few evidence-based approaches are available for managing pain in patients on chronic opioid therapy, particularly for those with postoperative pain. To address this gap, we developed a Perioperative Pain Program (PPP) to coordinate the continuum of care for surgical patients on chronic opioid therapy throughout the perioperative period. A multidisciplinary team, which included acute and chronic pain specialists and psychiatrists with expertise in addiction medicine, partnered with patients through preoperative consultation, postoperative inpatient hospitalization, and postoperative outpatient follow-up to develop personalized multimodal pain management plans and treat underlying psychiatric, behavioral, and psychological comorbidities. In the proposed project, we will evaluate the implementation and effectiveness of the PPP. To evaluate the implementation, we will apply a mixed methods approach with a convergent parallel design. Both quantitative and qualitative data will be collected and triangulated using different methods (chart reviews, observations, interviews). To evaluate the effectiveness, we will apply a quasi-experimental interrupted time series design comparing opioid prescription and patient self-reported outcomes (e.g., pain, functionality) between patients participating in PPP and a control group. In addition, we will adapt an educational program to improve patient engagement in the PPP. A pragmatic randomized trial will be done to assess the impact of the adapted program on patient engagement, opioid prescription, and other patient self- reported outcomes. This project focuses on prescription opioid use in perioperative pain management, which is a critical public health problem with significant consequences and costs. It will provides empirical evidence on the effectiveness of the PPP in preventing the overuse of prescription opioids and improving outcomes of surgical patients, which can inform future efforts to improve medication use and safety.