Opioid Prescribing and Chronic Pain in the Primary Care Setting

初级保健机构中的阿片类药物处方和慢性疼痛

• 批准号: 10456086
• 负责人: Katherine Elida Warren
• 金额: $ 5.43万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456086
• 关键词: Accounting; Advisory Committees; Affect; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chronic; Clinic; Clinical; Clinical Research; Clinics and Hospitals; Data; Databases; Disease; Dose; Emergency department visit; Environment; Epidemic; Epidemiologic Methods; Epidemiology; Ethnography; Fellowship; Goals; Guidelines; Hospitals; Incidence; Interruption; Intervention; Interview; Investigation; Knowledge; Length; Mediation; Mentors; Methodology; Mission; Morphine; National Institute of Drug Abuse; Neighborhoods; Opioid; Overdose; Pain; Pain management; Patient-Focused Outcomes; Patients; Pattern; Perception; Personal Satisfaction; Persons; Population; Prevalence; Primary Health Care; Professional Organizations; Qualitative Methods; Qualitative Research; Quality of life; Race; Recommendation; Research; Research Methodology; Research Proposals; Risk Behaviors; Safety; Self Perception; Socioeconomic Status; Statistical Methods; Structure; Substance Use Disorder; System; Time; Time Series Analysis; Training; United States; Woman; care outcomes; chronic pain; chronic pain management; chronic pain patient; clinical care; clinical implementation; cohort; ethnographic method; experience; health care service utilization; health disparity; health equity; improved; milligram; multidisciplinary; opioid misuse; opioid overdose; opioid use; opioid use disorder; overdose death; patient safety; prescription opioid; primary care setting; response; safety outcomes; stem; substance use

Project Summary/Abstract Amidst high levels of chronic pain, the United States (U.S.) has seen a concurrent opioid overdose epidemic that has led to the deaths of an estimated 702,000 people between 1999 and 2017. In response to the dramatic rise in opioid-related overdose deaths, a large proportion of interventions have targeted opioid prescribing and pain management. State, federal, and professional organization agencies have implemented changes intended to curb inappropriate opioid prescribing, particularly in the primary-care setting. This includes the release of the CDC Guideline for Prescribing Opioids for Chronic Pain in March 2016, a set of recommendations for primary-care opioid use in pain management. Between 2012 and 2018, U.S. opioid prescribing rates have subsequently fallen by more than one third. These changes have affected the estimated 1.6 million people with opioid use disorder and 50 million people with chronic pain. Concerns about the misapplication of guidelines have arisen, particularly in decisions to reduce or discontinue opioid prescribing among patients with chronic pain. The overall goal of this study is therefore to better characterize the impacts of new opioid prescribing guidelines and associated prescribing patterns for the treatment of chronic pain in the primary-care setting. All three specific aims draw from a hospital-system cohort of primary-care patients with chronic pain who are prescribed chronic opioids. Aim 1 consists of an interrupted time-series analysis to determine the magnitude of changes to opioid prescribing by dose, duration, and prescription type after the implementation of new opioid prescribing guidelines. Aim 2 entails semi-structured interviews with patients with chronic pain to explore the impact of prescribing and pain management changes on quality of life, functioning, pain management, opioid use, healthcare utilization, and perceptions of health equity. Aim 3 involves mediation analysis to determine whether certain patient groups have been disproportionately affected by opioid prescribing changes, particularly by race or socioeconomic status. The proposed research thus aligns with the National Institute on Drug Abuse’s (NIDA) stated goal to better understand the consequences of recent clinical care guideline implementation on opioid prescribing for pain management as well as its mission to support clinical research on substance use and associated disorders. The fellowship training plan includes rigorous methodological training in quantitative epidemiological and clinical ethnographic methods in a vibrant, multidisciplinary training environment. Through training and research, this proposal will help to better characterize the effects of recent efforts to reduce inappropriate opioid prescribing and the associated impacts on patient safety, patient wellbeing, and health equity. Such knowledge has the potential to improve chronic pain care and outcomes, promote responsible opioid prescribing, and lessen health disparities in the primary-care setting.

项目概要/摘要 在慢性疼痛严重的情况下，美国同时出现阿片类药物过量流行 1999 年至 2017 年间，估计有 702,000 人因此死亡。 与阿片类药物相关的过量死亡急剧上升，大部分干预措施都针对阿片类药物 州、联邦和专业组织机构已经实施了处方和疼痛管理。 旨在遏制不当阿片类药物处方的有意改变，特别是在初级保健环境中。 2016 年 3 月发布的 CDC 慢性疼痛阿片类药物处方指南 2012 年至 2018 年间美国阿片类药物在疼痛管理中的使用建议。 随后，这些变化影响了估计的处方率下降了三分之一以上。 160 万人患有阿片类药物使用障碍，5000 万人患有慢性疼痛。 指南的误用已经出现，特别是在减少或停止阿片类药物处方的决定中 因此，本研究的总体目标是更好地描述慢性疼痛患者的特征。 新的阿片类药物处方指南和相关处方模式对治疗的影响 所有三个具体目标均来自医院系统队列。 长期服用阿片类药物的初级保健患者的目标 1 包括中断治疗。 时间序列分析，以确定阿片类药物处方按剂量、持续时间和时间变化的幅度 新阿片类药物处方指南实施后的处方类型目标 2 需要半结构化。 采访慢性疼痛患者，探讨处方和疼痛管理变化的影响 关于生活质量、功能、疼痛管理、阿片类药物使用、医疗保健利用和健康认知 目标 3 涉及中介分析，以确定某些患者群体是否得到了公平对待。 受阿片类药物处方变化的影响尤其严重，特别是受到种族或社会经济地位的影响。 因此，拟议的研究符合国家药物滥用研究所 (NIDA) 的既定目标，即更好地 了解最近临床护理指南实施对阿片类药物止痛处方的影响 管理及其支持药物滥用和相关疾病临床研究的使命。 研究金培训计划包括定量流行病学和 通过培训和在充满活力的多学科培训环境中进行临床人种学方法。 研究表明，该提案将有助于更好地描述近期减少不当行为的努力的效果 阿片类药物处方及其对患者安全、患者福祉和健康公平的相关影响。 知识有可能改善慢性疼痛护理和结果，推广负责任的阿片类药物 处方，并减少初级保健环境中的健康差异。