Analgesic safety and effectiveness in older veterans with arthritis

患有关节炎的老年退伍军人的镇痛安全性和有效性

• 批准号: 10178089
• 负责人: Ula Y Hwang
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10178089
• 关键词: Address; Adverse event; Age-Years; Aging; Alcohol consumption; Analgesics; Arthritis; Cardiovascular system; Characteristics; Clinic; Clinical; Cohort Studies; Coxibs; Data; Data Collection; Data Set; Degenerative polyarthritis; Diagnosis; Disease; Dose; Effectiveness; Elderly; Evaluation; Event; Fracture; Frequencies; General Population; Geography; Goals; Guidelines; Health; Health behavior; Hepatic; Hip region structure; Hospitalization; Kidney; Knee Osteoarthritis; Link; Longitudinal Studies; Longitudinal cohort; Medicare/Medicaid; Medication Management; Methods; Military Personnel; Non-Steroidal Anti-Inflammatory Agents; Observational Study; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Patients; Pattern; Pharmaceutical Preparations; Population; Predictive Factor; Primary Health Care; Prospective cohort study; Recommendation; Regimen; Research; Research Design; Safety; Severities; Smoking; Surveys; Tobacco use; Trauma; Treatment outcome; United States National Institutes of Health; Veterans; arthritic pain; chronic pain; chronic pain management; chronic pain patient; cognitive function; cohort; comparative; comparative effectiveness study; compare effectiveness; comparison group; evidence base; falls; gastrointestinal; health service use; mortality; patient safety; prospective; recruit; respiratory; safety outcomes; treatment effect; treatment services

DESCRIPTION (provided by applicant): Background: Aging veterans are the largest growing cohort in the VHA population and pain related disorders are the most prevalent of health related conditions. Recent observational studies have raised questions about the safety and effectiveness of conventional analgesic regimens for pain treatment in older adults. In particular, these studies have raised concerns about the safety of opioids versus non-steroidal anti-inflammatory drugs (NSAIDs) of analgesics in older adults, medications commonly prescribed to veterans. Research gaps in optimal older adult pain treatment remain and more evidence-based research is needed before conclusive recommendations and guidelines can be endorsed. Objectives: The objectives of the following proposal are to expand upon the limitations of recent studies by evaluating the safety and effectiveness of 3 commonly used analgesic medications types (opioids, NSAIDs, coxibs) for patients with chronic pain. This will be done with 2 concurrent projects evaluating analgesic use in older veterans diagnosed with arthritis. The first will be a prospective cohort study, the secon will use national administrative data. Specific aims will be to determine: 1. the long-term safety of commonly used analgesic medications in older veterans diagnosed with arthritis, 2. the effectiveness of commonly used analgesic medications in older veterans diagnosed with arthritis, 3. the factors that predict positive and negative analgesic treatment outcomes for this cohort. Methods: To accomplish these objectives we will complete two projects targeting older (50+ years age) veterans with arthritis. The first study will prospectively survey older veterans with arthritis recruited from primary care clinics at four different VA centers with geographic and prescribing pattern diversity. Prospective data collection will allow us to address limitations identified with retrospective data use. These include collecting data on current pain levels, over the counter analgesic use, functional scores (including cognitive function), and health behavior factors (e.g., smoking). The second study use a national cohort of US veterans and replicate a controversial study comparing the safety of analgesics in a cohort of veterans with osteoarthritis. Using a longitudinal cohort of veterans from 2010-2014, the comparative safety of NSAIDs, selective coxibs, and opioids will be determined using both propensity score-matched cohorts and instrumental variable analyses. Veterans Health Administrative data, linked to Medicare and Medicaid claims data, will allow for a robust evaluation of patient safety outcomes.

描述（由申请人提供）： 背景：老年退伍军人是 VHA 人群中最大的增长群体，疼痛相关疾病是最普遍的健康相关疾病。最近的观察性研究对老年人疼痛治疗的传统镇痛方案的安全性和有效性提出了疑问。特别是，这些研究引起了人们对阿片类药物与非甾体抗炎药（NSAID）和老年人镇痛药（退伍军人常用药物）的安全性的担忧。最佳老年人疼痛治疗方面的研究差距仍然存在，需要更多基于证据的研究才能批准结论性建议和指南。目的：以下提案的目的是通过评估 3 种常用镇痛药物类型（阿片类药物、非甾体抗炎药、考昔布）对慢性疼痛患者的安全性和有效性，扩大近期研究的局限性。这将通过两个并行项目来完成，评估诊断患有关节炎的老年退伍军人的镇痛使用情况。第一个将是前瞻性队列研究，第二个将使用国家行政数据。具体目标是确定： 1. 诊断为关节炎的老年退伍军人常用镇痛药物的长期安全性， 2. 诊断为关节炎的老年退伍军人常用镇痛药物的有效性， 3. 预测阳性和阴性的因素该队列的镇痛治疗结果为阴性。方法：为了实现这些目标，我们将完成两个针对患有关节炎的老年（50 岁以上）退伍军人的项目。第一项研究将前瞻性地调查从四个不同的退伍军人事务部中心的初级保健诊所招募的患有关节炎的老年退伍军人，这些中心的地理和 规定模式多样性。前瞻性数据收集将使我们能够解决回顾性数据使用中发现的局限性。这些包括收集有关当前疼痛程度、非处方止痛药使用、功能评分（包括认知功能）和健康行为因素（例如吸烟）的数据。第二项研究使用了美国退伍军人全国队列，并重复了一项有争议的研究，比较了患有骨关节炎的退伍军人队列中镇痛药的安全性。 使用 2010-2014 年退伍军人的纵向队列，将使用倾向评分匹配队列和工具变量分析来确定非甾体抗炎药、选择性昔布和阿片类药物的相对安全性。退伍军人健康管理数据与医疗保险和医疗补助索赔数据相关联，将有助于对患者安全结果进行强有力的评估。