Barriers to and Health Consequences of Non- Pharmacological Chronic Pain Treatment among Patients Tapering Prescription Opioids in a Large Integrated Healthcare System

项目总结/摘要 意义长期阿片类药物治疗（LTOT），以前的标准治疗慢性疼痛，导致巨大的 与类阿片有关的发病率和死亡率增加。CDC因此发布了阿片类药物处方指南 2016年，退伍军人健康等医疗保健系统的LTOT下降了70% 管理（VHA）。LTOT逐渐减少或中止的风险尚不清楚，并且知识有限 关于用于补充LTOT锥度的治疗的障碍和临床有效性，例如 非药理学方式（NPM）。职业发展计划。曼尼斯博士的训练计划 包括研讨会、讲习班、课程和会议，以发展他在电子方面技能和专业知识 健康记录（EHR）研究方法，纵向和因果建模，以及卫生服务研究， 这是必要的进行他提出的研究计划，并实现他的职业目标，成为 一位独立的卫生服务科学家，他进行大型观察性研究， 慢性疼痛患者的临床护理。导师制。一个非常有成就的导师团队， 是生物统计学，慢性疼痛管理和物质使用流行病学的专家，将支持博士。 Mannes的研究和培训目标。研究计划。曼尼斯医生会对你的病人 根据Andersen的卫生服务利用模型进行的研究，该模型利用了 VHA EHR（每年约5，000，000名患者）回答以下问题：1）健康风险是什么 自CDC阿片类药物处方指南发布以来，LTOT逐渐减少或停止，2）是退伍军人 谁逐渐减少或停止LTOT更有可能接受NPM？3)在下列国家中，利用新公共管理的障碍是什么 逐渐减少或停止LTOT的患者？和4）使用NPM是否改善了以下患者的健康结果： 逐渐减少或停止LTOT？为了回答这些重要的问题，Mannes博士将利用回顾性 使用2016-2027年数据的纵向队列和横断面研究设计。广义线性 校正Kaplan-Meier生存曲线的Cox比例风险模型 社会人口统计学、临床和医疗机构特征将用于检查关联 LTOT逐渐减量与NPM之间的差异，包括护理终止、阿片类药物或疼痛相关急诊科就诊 或住院治疗，以及自杀或过量死亡。他的研究结果将为R 01提供信息， 第一批使用国家EHR数据来检查NPM的障碍，吸收和健康影响， 改造医疗补助统计信息系统。公共卫生影响。增加获得国家预防机制的机会 为易受慢性疼痛影响的人确定临床有效的NPM是高度优先的领域， NCCIH。这项研究将提供有关LTOT逐渐减少的后果的政策相关信息， NPM在非阿片类药物治疗慢性疼痛越来越多地被使用的时候。

PROJECT SUMMARY/ABSTRACT Significance. Long-term opioid therapy (LTOT), previously standard care for chronic pain, led to enormous increases in opioid-related morbidity and mortality. The CDC therefore issued opioid prescribing guidelines in 2016, which was followed by a 70% decline in LTOT in healthcare systems such as the Veterans Health Administration (VHA). Risks of LTOT taper or discontinuation are unclear and there is limited knowledge about the barriers to and clinical effectiveness of the treatments used to supplement LTOT taper, such as non-pharmacological modalities (NPM). Career Development Plan. Dr. Mannes’ training program will include seminars, workshops, coursework, and conferences to develop his skills and expertise in electronic health record (EHR) research methods, longitudinal and causal modeling, and health services research, which are necessary for conducting his proposed research plan and achieving his career goals of becoming an independent health services scientist who conducts large observational studies that will inform the clinical care of people living with chronic pain. Mentorship. A highly accomplished team of mentors who are experts in biostatistics, chronic pain management, and substance use epidemiology, will support Dr. Mannes’ research and training goals. Research Plan. Dr. Mannes will conduct a clinical epidemiological study informed by Andersen’s Model of Health Service Utilization that leverages the size and scope of the VHA EHR (~5,000,000 patients each year) to answer the following questions: 1) What are the health risks of LTOT taper or discontinuation since release of the CDC opioid prescribing guidelines, 2) Are veterans who taper or discontinue LTOT more likely to receive NPM? 3) What are barriers to NPM utilization among patients who taper or discontinue LTOT? and 4) Does NPM use improve health outcomes for patients who taper or discontinue LTOT? To answer these important questions, Dr. Mannes will utilize retrospective longitudinal cohort and cross-sectional study designs using data from 2016-2027. Generalized linear models and Cox-proportional hazard models with Kaplan-Meier survival curves adjusted for sociodemographic, clinical, and healthcare facility characteristics will be used to examine associations between LTOT taper and NPM with care termination, opioid or pain-related emergency department visits or hospitalization, and suicide or overdose mortality. Findings from his study will inform an R01 that will be among the first to use national, EHR data to examine barriers, uptake, and health effects of NPM using the Transformed Medicaid Statistical Information System. Public Health Impact. Increasing access to NPM and identifying clinically effective NPM for people vulnerable to chronic pain are high priority areas for NCCIH. This research will provide policy-relevant information on the consequences of LTOT tapering and NPM at a time when non-opioid therapies for chronic pain are becoming increasingly utilized.