SPOiLER: towards Safer Prescribing of Legal Opioids from the Emergency Room

剧透：在急诊室更安全地开出合法阿片类药物

基本信息

批准号：
10364730
负责人：
William Edward Soares
金额：
$ 18.47万
依托单位：
BAYSTATE MEDICAL CENTER, INC.
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10364730
关键词：
Accident and Emergency department Acute Applications Grants Attitude Behavior Behavioral Belief Benefits and Risks Characteristics Chronic Clinical Cohort Analysis Data Databases Dependence Development Drug Monitoring Drug Prescriptions Education Emergency Department Physician Emergency Department patient Emergency Situation Epidemic Equilibrium Event Evidence based practice Frequencies Funding Future Goals Grant Harm Reduction Hospitals Individual Interview Leadership Legal Massachusetts Mentors Methods National Institute of Drug Abuse New Hampshire Opioid Outpatients Overdose Pain Patient-Focused Outcomes Patients Physicians Planning Theory Policies Policy Research Probability Provider Qualitative Methods Quasi-experiment Regulation Research Research Personnel Research Project Grants Retrospective cohort Risk Role State Government Statutes and Laws Structure Substance Use Disorder Training United States addiction adverse outcome base behavior change behavioral outcome career development clinically relevant evidence base evidence based guidelines experience health care service utilization implementation trial indexing nonmedical use opioid epidemic opioid policy opioid therapy opioid use opioid use disorder peer pill prescription opioid prevent social norm theories

项目摘要

PROJECT SUMMARY The objective of this NIDA K08 career development proposal is to gain experience and training to become an independent investigator focused on the development of evidence-based practices to prevent and treat substance use disorders in the emergency department. Opioid use disorders, including overdose and addiction, have become epidemic in the United States. While research has largely focused on long-term opioid prescribing in the outpatient setting, emergency department opioid prescribing for acute painful conditions as a portal for future adverse patient outcomes remains poorly defined. State governments, including the Commonwealth of Massachusetts, have reacted to the opioid crisis in part by crafting legislation to broadly limit legal opioid prescriptions. However, opioid medications remain an important treatment option for some acute painful conditions, and evidence based guidance on appropriate prescribing is lacking, in part because the factors that impact providers opioid prescribing behaviors and subsequent patient associated adverse outcomes remains unknown. Understanding the underlying factors that influence opioid prescribing behaviors and future patient outcomes, including state legislation, peer behaviors, hospital attitudes, and local culture, is a critical step in developing integrated, evidence-based recommendations that focus on transforming the culture surrounding safe opioid prescribing practices. Using the theory of planned behavior as a framework, the goals of this K08 grant application are to understand opioid prescribing behaviors and adverse patient outcomes through the following aims: First, we will assess the influence of state legislation, specifically the 2016 Massachusetts (MA) Opioid Law, on the formation of hospital-based regulations and providers' perceived attitudes towards opioid prescribing through qualitative interviews with local physician leaders in MA. Second, using comprehensive claims data, we will evaluate the impact of the 2016 MA Opioid Law on statewide opioid prescribing, using a neighboring state without opioid legislation as a natural control. Finally, we will examine the association of an initial opioid prescription on clinically relevant patient outcomes in order to better understand how restricting opioid prescriptions through legislation may impact emergency department patients presenting with an acute painful condition. From our results, we will create evidence-based recommendations to enhance existing opioid legislation, as well as develop and execute R01 funded comprehensive implementation trials that focus not only on changing behaviors of individual providers, but also transforming the group culture and social norms that influence opioid prescribing behaviors. !

项目概要 NIDA K08 职业发展建议的目标是获得经验和培训成为一名独立调查员，专注于开发基于证据的实践，以预防和在急诊科治疗药物滥用障碍。阿片类药物使用障碍，包括过量和成瘾，在美国已成为一种流行病。虽然研究主要集中在长期阿片类药物在门诊、急诊室开阿片类药物治疗急性疼痛情况未来患者不良结果的门户仍然不明确。包括马萨诸塞州在内的州政府已对阿片类药物危机做出了反应部分方法是制定立法来广泛限制合法的阿片类药物处方。然而，阿片类药物仍然是一种一些急性疼痛病症的重要治疗选择，以及适当的循证指导缺乏处方，部分原因是影响提供者阿片类药物处方行为的因素和随后与患者相关的不良后果仍然未知。了解底层影响阿片类药物处方行为和未来患者结果的因素，包括国家立法、同行行为、医院态度和当地文化，是制定综合的、基于证据的关键一步重点关注改变阿片类药物安全处方文化的建议。以计划行为理论为框架，本次 K08 拨款申请的目标是通过以下目标了解阿片类药物处方行为和不良患者结果：首先，我们将评估州立法，特别是 2016 年马萨诸塞州 (MA) 阿片类药物法对通过以下方式形成基于医院的法规和提供者对阿片类药物处方的认知态度：对马萨诸塞州当地医生领导者的定性访谈。其次，利用综合理赔数据，我们将使用邻近州评估 2016 年 MA 阿片类药物法对全州阿片类药物处方的影响没有阿片类药物立法作为自然控制。最后，我们将检查初始阿片类药物的关联根据临床相关患者结果开具处方，以便更好地了解如何限制阿片类药物通过立法的处方可能会影响急诊室的急性疼痛患者健康）状况。根据我们的结果，我们将提出基于证据的建议，以增强现有的阿片类药物立法，以及制定和执行 R01 资助的全面实施试验，重点不在于不仅要改变个体提供者的行为，还要改变群体文化和社会规范影响阿片类药物处方行为。！