Chronic Opioid Therapy and Patient Safety in HIV Infected and Uninfected Veterans

HIV 感染和未感染退伍军人的慢性阿片类药物治疗和患者安全

• 批准号: 8527077
• 负责人: Julie Rozelle Gaither
• 金额: $ 4.22万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8527077
• 关键词: Accidents; Accounting; Address; Adherence; Affect; Afghanistan; Aging; American; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chronic; Chronic Disease; Clinical; Clinical Research; Cocaine; Cohort Studies; Color; Conflict (Psychology); Country; Data; Data Analyses; Department of Defense; Drug Prescriptions; Economics; Growth; Guideline Adherence; Guidelines; HIV; Healthcare; Healthcare Systems; Heroin; Injury; Iraq; Link; Medicine; Mission; Modeling; Nurses; Opiate Addiction; Opioid; Outcome; Overdose; Pain; Pain management; Patient Monitoring; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Physicians; Play; Prospective Studies; Provider; Public Health; Relative Risks; Research; Resources; Risk; Risk Assessment; Role; Rosa; Safety; Sales; Societies; Source; Substance Use Disorder; Substance abuse problem; System; Testing; Training and Education; United States Department of Veterans Affairs; Veterans; Violence; Work; addiction; cancer pain; care seeking; clinical practice; disorder prevention; end of life; evidence base; falls; high risk; milligram; mortality; non-cancer pain; opioid abuse; overdose death; patient safety; prescription opioid; primary outcome; public health relevance; secondary outcome; trend; vehicular accident

DESCRIPTION: Prescription opioids, drugs once reserved for the treatment of end-of-life cancer pain, have recently become a mainstay in the treatment of chronic non-cancer pain (CNCP), a trend that is increasingly controversial. Limited data exist to support the safety and efficacy of chronic opioid therapy (i.e., long-term opioid use), and risk for misuse is elevated in patients with psychiatric illness and substance use disorders. Despite these concerns, prescriptions for CNCP continue to rise, as evidenced by the substantial growth in retail pharmacy sales in recent years: from 1997 to 2006, the number of opioid prescriptions dispensed in the U.S. increased by 48%, and the amount of medication dispensed per person rose by 368% (from 74 to 369 milligrams per capita, according to the U.S. Drug Enforcement Agency). Mirroring these trends has been a rise in unintentional overdose deaths and unprecedented levels of addiction to prescription drugs. These data underscore the need for clinician adherence to evidence-based opioid treatment guidelines, first introduced in 1997 to promote the safe and efficacious use of prescription opioids for CNCP management. The overall objective of this proposal is to describe clinician adherence to evidence-based opioid treatment guidelines and to examine the association between guideline adherence and patient safety, among HIV+ and HIV- patients. We hypothesize that clinicians are not delivering guideline concordant care, which is putting patients and the public at risk. To test this hypothesis, we will carryout three specific aims: 1) describe clinician adherence to guidelines for the provision of chronic opioid therapy; 2) examine, using survival regression models, the longitudinal association between guideline adherence and patient deaths (all-cause, overdose, and violent); and 3) explore the moderating effects of psychiatric and substance use disorders on this relationship. To accomplish these aims, we will conduct a secondary analysis of data from the Veterans Aging Cohort Study (VACS): an observational, prospective study of HIV+ and HIV- veterans. With this data, we will have access to clinical, administrative, and pharmacy data on a vulnerable patient group for which CNCP, psychiatric illness, and substance use disorders are prevalent. This project has implications for clinician education and training, which federal agencies have identified as a top priority for addressing the country's fastest-growing drug problem, opioid abuse. This research is also aligned with NIDA's recent initiative to support clinical research to protect against opioid abuse and addiction. Finally, this work is consistent with NIDA's mission to address HIV, and co-occurring conditions, in the context of substance abuse.

描述：处方阿片类药物，曾经保留用于治疗寿命终止癌症疼痛的药物，最近已成为治疗慢性非癌症疼痛（CNCP）的中流tay柱，这一趋势越来越有争议。存在有限的数据以支持慢性阿片类药物治疗的安全性和有效性（即长期使用阿片类药物），并且滥用风险在 患有精神病和药物使用障碍的患者。 Despite these concerns, prescriptions for CNCP continue to rise, as evidenced by the substantial growth in retail pharmacy sales in recent years: from 1997 to 2006, the number of opioid prescriptions dispensed in the U.S. increased by 48%, and the amount of medication dispensed per person rose by 368% (from 74 to 369 milligrams per capita, according to the U.S. Drug Enforcement Agency).反映这些趋势的反映是无意过量的过量死亡和对处方药的前所未有的成瘾水平的上升。这些数据强调了临床医生遵守基于证据的阿片类药物治疗指南的需求，该指南于1997年首次介绍，以促进对CNCP管理的处方阿片类药物的安全有效使用。该提案的总体目的是描述临床医生遵守基于证据的阿片类药物治疗指南，并检查HIV+和HIV患者之间的指南遵守与患者安全之间的关联。我们假设临床医生没有提供指南协调，这使患者和公众处于危险之中。为了检验这一假设，我们将 随身携带三个具体目的：1）描述临床医生遵守慢性阿片类药物治疗的指南； 2）使用生存回归模型检查指南依从性与患者死亡（全因，服用过量和暴力）之间的纵向关联； 3）探索精神病和物质使用障碍对这种关系的调节作用。为了实现这些目标，我们将对退伍军人老化队列研究（VACS）的数据进行二次分析：HIV+和HIV-退伍军人的观察性，前瞻性研究。有了这些数据，我们将可以获取有关CNCP，精神病和药物使用障碍的脆弱患者组的临床，行政和药房数据。该项目对临床医生的教育和培训具有影响，联邦机构已将其确定为解决该国增长最快的药物问题，阿片类药物滥用的重中之重。这项研究还与NIDA最近的主动行动保持一致，以支持临床研究，以防止阿片类药物滥用和成瘾。最后，这项工作与NIDA在药物滥用的背景下解决艾滋病毒和同时发生条件的使命是一致的。