Improving Opioid Prescription Safety After Surgery

项目摘要 手术后过量处方的阿片类药物可能会产生阿片类药物的储存库，这些阿片类药物可用于非医疗类药物 使用。缺乏有效的策略来最大限度地利用非阿片类止痛疗法，并限制这类药物的储存。因此， 迫切需要研究阿片类药物的使用模式，并使术后疼痛治疗个体化。这个 这项拟议研究的基本原理是，一旦我们更好地了解了出院后阿片类药物的使用 我们可以改善疼痛管理，显著减少不必要的阿片类药物处方。我们的 中心假设是手术后的疼痛治疗可以以个性化和更安全的方式进行，如 与目前采用的“一刀切”或非数据驱动的方法相反。为了检验我们的假设，有三个 提出目标：具体目标#1将检查患者和程序之间的关系 术后阿片类药物的特点及长期用药。这项回顾性队列研究包括6442名患者和 将利用临床和基于索赔的数据库。具体目标#2将检查患者和程序 评估术后疼痛结果和预测术后阿片类药物使用模式的特征 做手术。使用调查方法，我们将评估疼痛强度和干扰，并量化消耗 600例患者术后应用阿片类药物。将开发一个预测处方阿片类药物高使用量与低使用量的模型。 具体目标#3将前瞻性地测试集成到电子病历中的决策支持工具 出院后外科手术患者116例。该工具将预测阿片类药物的实际需求，并 使患者能够最大限度地使用非阿片类止痛药。限制阿片类药物过量处方和最大化 非阿片类药物有可能大幅减少可用于非医疗用途的阿片类药物数量 同时改善术后疼痛控制。申请人是一名麻醉师，曾接受过以下专业培训 止痛药，提出了一个为期五年的职业发展计划，以补充研究提案。这 结合了一位在预防医疗保健方面具有专业知识的知名调查员的密切指导 高危人群中药物使用的并发症。由具有专业知识的关键教员组成的指导团队 在成瘾的精神病学角度，生物统计学和卫生信息技术将支持初级 门托。此外，应聘者还制定了详细的教学计划，其中包括专业培训 了解阿片类药物使用障碍、流行病学、健康信息技术和临床试验。这个 候选人的长期目标是发展成为一名独立的临床科学家，拥有药物滥用和 强调术后疼痛治疗的安全和有效提供拟议的研究，作为 申请人实现长期目标的关键第一步，意义重大，因为这将填补现有的 在遏制美国阿片类药物流行和加强术后疼痛管理方面的知识差距。

Project Summary Over-prescribed opioids after surgery can create a reservoir of opioids that become available for non-medical use. Effective strategies to maximize non-opioid pain therapy and to limit such a reservoir are lacking. Thus, there is an urgent need to study opioid usage patterns and to individualize post-operative pain therapy. The rationale that underlies the proposed research is that once we better understand post-discharge opioid use patterns, we can improve pain management and significantly decrease unnecessarily prescribed opioids. Our central hypothesis is that pain therapy after surgery can be prescribed in an individualized and safer fashion, as opposed to “one size fits all” or non-data driven methods currently employed. To test our hypothesis, three aims are proposed: Specific aim #1 will examine the relationship between patient and procedural characteristics and long-term opioid prescriptions after surgery. This retrospective cohort study includes 6442 patients and will utilize both clinical and claims-based databases. Specific aim #2 will examine patient and procedural characteristics to assess post-operative pain outcomes and predict use patterns for opioids prescribed after surgery. Using survey methods, we will assess pain intensity and interference and quantify consumption of opioids in 600 patients after surgery. A model to predict high vs. low use of prescribed opioids will be developed. Specific aim #3 will prospectively test a decision support tool integrated into the electronic medical record in 116 surgical patients after hospital discharge. The tool will predict actual need for opioid medications and empower patients to maximize non-opioid analgesics. Limiting excess prescription of opioids and maximizing non-opioid medications has the potential to dramatically reduce the amount of opioids available for non-medical use while improving post-operative pain control. The applicant, an anesthesiologist with subspecialty training in pain medicine, proposes a five-year career development program to compliment the research proposal. This incorporates close mentoring by a well-established investigator with expertise in preventing medical complications of drug use in high-risk populations. A mentoring team composed of key faculty members with expertise in psychiatric perspectives of addiction, biostatistics, and health information technology will support the primary mentor. In addition, the candidate has developed a detailed didactic plan that includes training in specialty knowledge in opioid use disorders, epidemiology, health information technology, and clinical trials. The candidate's long-term goal is to develop into an independent clinical scientist with expertise in drug abuse and emphasis on safe and effective delivery of pain therapy after surgery The proposed research, which serves as the key first step towards the applicant reaching his long-term goal, is significant because it will fill the existing gaps in knowledge to curb the United States opioid epidemic and enhance postoperative pain management.