Strategies for Improving Prescription Opioid Use in Perioperative Pain Management

项目概要 处方阿片类药物用于疼痛管理的使用增加，导致全国范围内的公共卫生 危机在手术环境中，协调不良的疼痛管理导致术后过量的阿片类药物处方。 外科手术，它颁布了阿片类药物转移，滥用和依赖的门户。慢性病患者 手术前的阿片类药物存在特殊风险，因为它们在手术后需要更高的阿片类药物剂量， 适当的疼痛控制。然而，很少有基于证据的方法可用于管理患者的疼痛 慢性阿片类药物治疗，特别是对于那些术后疼痛。为了解决这个问题，我们开发了一个 围手术期疼痛计划（PPP），以协调长期使用阿片类药物的手术患者的连续护理 整个围手术期的治疗。一个多学科团队，包括急性和慢性疼痛 具有成瘾医学专业知识的专家和精神科医生，通过术前 咨询，术后住院治疗，术后门诊随访，以制定 个性化的多模式疼痛管理计划和治疗潜在的精神，行为， 心理共病在建议的计划中，我们会评估 的PPP。为了评估实现，我们将应用具有收敛并行的混合方法。 设计将收集定量和定性数据，并使用不同的方法进行三角测量（图 评论、观察、访谈）。为了评估其有效性，我们将采用一种准实验方法， 中断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）之间的患者参与PPP和对照组。此外，我们将调整一个 教育计划，以提高病人参与PPP。将进行一项实用的随机试验， 评估调整后的计划对患者参与、阿片类药物处方和其他患者自我的影响。 报告结果。该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， 这是一个严重的公共卫生问题，具有重大后果和成本。它将提供经验证据， PPP在预防处方阿片类药物过度使用和改善 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.