Prolonged Use of Pain Medication Past the Postoperative Period in Older Adults

项目Summary/Abstract……………………………………………………………………………………………… 这是为Tasce Bongiovanni医生申请K23奖的申请书，他是一名急性护理、创伤和外科危重病患者 加州大学旧金山分校(UCSF)护理内科医生。Bongiovanni博士正在确立她自己的地位 在以患者为中心的研究中使用实施科学来防止长期使用疼痛的研究人员 老年人术后期间的用药情况。尽管短期使用非阿片类药物 可能适合术后疼痛控制，长期使用可能会导致老年人出现不良事件 包括增加住院和死亡的风险，应该避免。 然而，a 转变为 由阿片类药物流行推动的多模式止痛方案的发生没有注意到确保 适当地停止阿片类药物的使用。 由于老年人约占所有老年人的一半 在美国，手术的比例预计会随着人口的迅速老龄化而增加，这一比例更深 了解长期使用非阿片类药物是一个紧迫的公共卫生问题。 这个 这项K23提案的目标是通过有针对性的循证干预更好地理解和解决问题， 老年人术后长期使用止痛药。我的中心假设是 术后止痛药在老年人中很常见，随着外科医生转向多模式，情况变得更糟 这种现象很大程度上是由于护理之间缺乏沟通和协调。 团队和病人。这项提案的目标是：1.在具有全国代表性的医疗保险人群中，定义 术后长期使用止痛药的流行病学研究，包括患者、临床医生 和健康系统风险因素；2.对临床医生和老年患者进行定性访谈，并 他们的照顾者记录在术后期间长期使用止痛药的经历 获得有关计划的试点干预的反馈，以解决这些问题和3.试点干预以 防止老年人术后长期使用术后止痛药。这样做的目的是 建议的目的是直接支持职业发展活动，重点是培训1。 高级统计分析，特别是医疗保险数据；2.稳健的定性方法；3.设计和 评估老年人的有效实施战略和4.职业发展和领导力， 专注于老年人的手术，长期的职业目标是将临床和研究结合起来 改善老年人术后护理和用药的兴趣。Bongiovanni博士将进行这项工作 与斯坦曼博士领导并嵌入加州大学洛杉矶分校胡椒中心的卓越指导团队合作。 这项K23建议将促进我们对长期使用疼痛的风险因素和驱动因素的了解 在术后期间用药，并利用这些知识来设计、提炼和测试可行性和 防止老年人长时间使用的干预措施的可接受性。它还将提供先进的研究 技能和宝贵的数据来启动Bongiovanni博士作为一名独立调查员的职业生涯 手术和衰老。数据和培训计划将共同构成令人信服的R01提案的基础 改善老年人的术后护理。

Project Summary/Abstract……………………………………………………………………………………………… This is an application for a K23 award for Dr. Tasce Bongiovanni, an acute care, trauma and surgical critical care physician at University of California, San Francisco (UCSF). Dr. Bongiovanni is establishing herself as an investigator in patient-oriented research using implementation science to prevent the prolonged use of pain medications in older adults in the postoperative period. Although short-term use of opioid-sparing medications may be appropriate for postoperative pain control, long-term use in older adults can lead to adverse events including increased risk of hospitalization and death, and should be avoided. However, a shift towards multimodal pain regimens driven by the opioid epidemic has taken place without attention to ensuring that opioid-sparing medications are discontinued appropriately. Since older adults account for roughly half of all surgeries in the United States, a proportion expected to increase as the population rapidly ages, a deeper understanding of prolonged use of opioid-sparing medication is an urgent public health concern. The objective of this K23 proposal is to better understand and address, via a targeted, evidence-based intervention, prolonged used of postoperative pain medication in older adults. My central hypothesis is that continuation of pain medication postoperatively is common in older adults, has worsened as surgeons shift to multimodal regimens, and that this phenomenon is largely due to lack of communication and coordination between care teams and patients. The aims of this proposal are: 1. In a nationally representative Medicare population, define the epidemiology of prolonged use of pain medications prescribed postoperatively, including patient, clinician and health system risk factors; 2. Conduct qualitative interviews with clinicians and older adult patients and their caregivers to document experiences of prolonged use of pain medication in the postoperative period and obtain feedback about a planned pilot intervention to address these issues and 3. Pilot an intervention to prevent the prolonged use of postoperative pain medication for older adults after surgery. The aims of this proposal are developed to directly support career development activities with a focus on training in 1. Advanced statistical analysis, specifically of Medicare data; 2. Robust qualitative methodology; 3. Design and evaluate effective implementation strategies for older adults and 4. Career development and leadership, focused on surgery in older adults, with the long-term goal career goal to combine her clinical and research interests to improve postoperative care and medication use in older adults. Dr. Bongiovanni will conduct this work with an exceptional mentoring team, led by Dr. Steinman and embedded in the UCSF Pepper Center. This K23 proposal will advance our knowledge of the risk factors and drivers of prolonged use of pain medication in the postoperative period, and use this knowledge to design, refine and test the feasibility and acceptability of an intervention to prevent prolonged use for older adults. It will also provide advanced research skills and valuable data to launch Dr. Bongiovanni’s career as an independent investigator at the intersection of surgery and aging. Together, the data and training plan will form the basis for a compelling R01 proposal to improve postoperative care for older adults.