The Effect of Medical Cannabis Laws on Health Care Use in Insured Populations with Pain-S1

医用大麻法对疼痛 S1 参保人群医疗保健使用的影响

• 批准号: 10393350
• 负责人: W David Bradford
• 金额: $ 56.92万
• 依托单位: UNIVERSITY OF GEORGIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10393350
• 关键词: Activities of Daily Living; Affect; Alcohol consumption; American College of Obstetricians and Gynecologists; Anxiety; Biological; COVID-19; COVID-19 pandemic; Cannabis; Censuses; Cesarean section; Characteristics; Clinical; Computerized Medical Record; Contracts; County; Data; Data Sources; General Population; Goals; Health; Health Care Visit; Health Services Accessibility; Healthcare; Hospitalization; Hospitals; Hour; Incidence; Individual; Infant; Laws; Lead; Measures; Medical Marijuana; Mental Depression; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Patients; Perinatal; Persistent pain; Persons; Population; Postpartum Period; Postpartum Women; Pregnant Women; Privatization; Provider; Public Health; Public Policy; Reporting; Risk; Running; Social isolation; Source; Stress; Time; United States; Vagina; Virus; Visit; Vulnerable Populations; Woman; barrier to care; base; behavioral response; chronic pain; experience; follow-up; health care availability; health care service utilization; health disparity; health of the mother; individual patient; longitudinal analysis; marijuana legalization; marijuana use; maternal morbidity; member; mortality; non-opioid analgesic; novel; opioid use; opportunity cost; pandemic disease; parent grant; postpartum care; postpartum health; postpartum morbidity; prenatal; prescription opioid; prescription pain reliever; rural residence; service intervention

Project Summary The COVID-19 pandemic has substantially disrupted routine healthcare and exacerbated existing barriers to healthcare access for the population. Our proposal will provide new evidence on the impact of the COVID-19 pandemic for a particularly vulnerable population: postpartum women. Approximately two-thirds of women report pain that interferes with Activities of Daily Living at 24 hours postpartum; 6 to 18% of women experience chronic pain after delivery. Thus, disruption to routine healthcare has the potential to substantially worsen pain and subsequent health for postpartum women. Our proposed study will examine the effect of the COVID-19 pandemic on postpartum women’s pain-related healthcare utilization, with specific focus on the prescription of opioid analgesics at hospital discharge after delivery and during the subsequent six-month postpartum period. In addition, we will examine the extent to which the impact of the pandemic differed systematically for women with versus without access to recreational or medical cannabis, thus building on preliminary evidence that there is substitution away from opioid analgesic prescriptions in states that implement recreational and medical cannabis laws. Our analyses will leverage data from two large secondary data sources: Optum claims data and HealthJump electronic medical records data, in conjunction with data on active cannabis dispensaries and U.S. Census data. We will employ a patient-level panel data approach to examine changes in healthcare utilization that coincided with the start of the COVID-19 pandemic, controlling for individual patient characteristics, state and county time-varying characteristics, and state fixed effects. In addition, we will interact our measure of pandemic exposure with measures of access to legal cannabis and conduct sub-analyses in which we allow for potential differential effects by delivery type (vaginal or Cesarean), by prior opioid use, and by urban versus rural residence. These novel analyses will provide the first longitudinal, patient-level analysis of the relationship between COVID-19 and pain-related healthcare utilization for postpartum women, as well as the first evidence on the interaction between legal cannabis access and utilization of prescription pain medication among postpartum women. Understanding these relationships is essential in order to optimize public policies and to provide guidance to clinical practitioners on mitigation of long-run impacts of the COVID-19 pandemic.

项目概要 COVID-19 大流行严重扰乱了常规医疗保健并加剧了现有的障碍 我们的提案将为了解 COVID-19 的影响提供新的证据。 这一流行病针对的是特别脆弱的人群：大约三分之二的妇女。 6% 至 18% 的女性表示产后 24 小时会出现影响日常生活活动的疼痛； 因此，常规医疗保健的中断有可能使疼痛严重恶化。 以及产后妇女的后续健康。 我们拟议的研究将探讨 COVID-19 大流行对产后妇女疼痛相关的影响 医疗保健利用，特别关注出院后阿片类镇痛药的处方 此外，我们还将检查分娩期间和产后六个月的情况。 对于有和没有娱乐机会的妇女来说，大流行的影响存在系统性差异 或医用大麻，因此建立了阿片类镇痛药替代品的初步证据 实施娱乐和医用大麻法的州的处方。 我们的分析将利用来自两个大型二手数据源的数据：Optum 索赔数据和 HealthJump 电子医疗记录数据，以及活跃大麻药房和美国人口普查的数据 我们将采用患者级别的面板数据方法来检查医疗保健利用率的变化。 恰逢 COVID-19 大流行的开始，控制了患者的个体特征、状态和 此外，我们还将对县的时变特征和州固定效应进行交互。 通过获取合法大麻的措施进行大流行暴露，并进行亚分析，其中我们允许 不同分娩方式（阴道或剖腹产）、既往阿片类药物使用情况以及城市与城市的潜在差异效应 农村住宅。 这些新颖的分析将首次对患者之间的关系进行纵向、患者层面的分析。 COVID-19 和产后妇女与疼痛相关的医疗保健利用情况，以及关于这一点的第一个证据 产后合法大麻获取与处方止痛药使用之间的相互作用 了解这些关系对于优化公共政策和提供服务至关重要。 为临床从业者提供关于减轻 COVID-19 大流行的长期影响的指南。