Improving urine drug test utility to mitigate prescription opioid risk

改善尿液药物测试实用性以降低处方阿片类药物风险

基本信息

批准号：
9882980
负责人：
Marc Larochelle
金额：
$ 19.11万
依托单位：
BOSTON MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-03-01 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9882980
关键词：
American Care given by nurses Case Manager Chronic Classification Clinical Clinical Data Clinical Investigator Community Health Networks Complex Computerized Medical Record Data Data Sources Detection Development Effectiveness Equilibrium Expert Opinion Funding Goals Guidelines Health Services Research Hospitals Internist Intervention K-Series Research Career Programs Knowledge Measures Mentors Mentorship Methodology Methods Monitor National Institute of Drug Abuse Neighborhood Health Center Observational Study Opioid Pain management Pathway interactions Patients Physicians Primary Health Care Provider Quality Indicator Randomized Randomized Clinical Trials Recommendation Reporting Research Research Personnel Research Project Grants Resources Respondent Risk Safety Sales Sampling Stream Surveys Test Result Testing Time Training United States National Institutes of Health Urine Work addiction adjudicate base career chronic pain clinical data warehouse clinical database clinical decision support clinical practice cohort design dosage drug metabolism drug testing effectiveness testing electronic data evidence base experience implementation science improved multi-component intervention non-cancer chronic pain novel opioid therapy overdose death patient oriented performance tests point of care prescription opioid primary outcome research and development response risk mitigation safety net skills support tools tool

项目摘要

PROJECT SUMMARY An estimated 100 million Americans suffer from chronic pain, and 5 to 8 million are prescribed chronic opioids for pain management. Overdose deaths due to prescription opioids more than quadrupled between 1999 and 2010, mirroring increases in prescription opioid sales. There is a dearth of evidence-based tools to support providers in the challenging task of balancing potential benefits with known risks of prescription opioid therapy. Guidelines commonly recommend urine drug testing (UDT) as a risk monitoring tool for patients prescribed opioids for chronic non-cancer pain. UDTs can identify misuse or diversion through detection of illicit or non- prescribed controlled substances or absence of prescribed opioids. However, UDTs are challenging to interpret, requiring detailed understanding of complex drug metabolism pathways, and data suggest physicians frequently err in UDT interpretation. Observational studies suggest between 31% and 55% of UDTs are consistent with potential misuse or diversion, but there are scant data on how providers respond to these UDT results. Development of effective risk mitigation strategies for patients prescribed opioids for chronic pain is a key priority for NIH/NIDA. The current proposal seeks to develop and validate a method to identify unexpected UDT results consistent with misuse or diversion using EMR data. We will use this method to characterize the rates of, predictors of, and clinical response to unexpected UDT results in a large cohort of patients receiving chronic opioid therapy. Finally, we will evaluate the acceptability and efficacy of a clinical decision support tool that includes interpretation of UDT results with or without clinical response guidance. Through the Mentored Career Development Award, the candidate will develop skills necessary for transition to an independent research career, including advanced training in research using large clinical databases, training in intervention and implementation science, and development of research-related content and methodological expertise in chronic pain and addiction. The knowledge gained from the proposed scope of work will inform further studies to test the performance of the method to identify unexpected UDT results consistent with misuse or diversion as a quality indicator in a large clinical data research network, and pilot-testing the UDT clinical decision support tool in clinical practice.

项目概要据估计，有 1 亿美国人患有慢性疼痛，其中 5 至 800 万人服用慢性阿片类药物用于疼痛管理。 1999 年至 1999 年期间，因处方阿片类药物过量死亡的人数增加了四倍多 2010 年，处方阿片类药物销售量也出现增长。缺乏基于证据的工具来支持提供者面临着平衡处方阿片类药物治疗的潜在益处和已知风险的艰巨任务。指南通常推荐尿液药物检测（UDT）作为处方患者的风险监测工具阿片类药物用于治疗慢性非癌症疼痛。 UDT 可以通过检测非法或非非法行为来识别滥用或转移处方受控药物或没有处方阿片类药物。然而，UDT 具有挑战性解释，需要详细了解复杂的药物代谢途径，数据表明医生 UDT 解释经常出错。观察性研究表明 31% 到 55% 的 UDT 是与潜在的滥用或转移一致，但关于提供商如何响应这些 UDT 的数据很少结果。为治疗慢性疼痛的阿片类药物患者制定有效的风险缓解策略是一个重要的任务 NIH/NIDA 的重点优先事项。当前的提案旨在开发和验证一种方法来识别意外情况 UDT 结果与 EMR 数据的滥用或转移一致。我们将使用这种方法来表征在一大群接受治疗的患者中，意外 UDT 结果的发生率、预测因素和临床反应慢性阿片类药物治疗。最后，我们将评估临床决策支持工具的可接受性和有效性其中包括在有或没有临床反应指导的情况下对 UDT 结果的解释。通过辅导职业发展奖，候选人将培养过渡到独立的必要技能研究生涯，包括使用大型临床数据库进行研究的高级培训、干预培训和实施科学，以及研究相关内容和方法专业知识的发展慢性疼痛和成瘾。从拟议的工作范围中获得的知识将为进一步的研究提供信息测试该方法的性能，以识别与滥用或转移一致的意外 UDT 结果作为大型临床数据研究网络中的质量指标，并对 UDT 临床决策进行试点测试临床实践中的支持工具。