Assessing the Safety and Effectiveness of Opioid Tapering in Large Health Systems

评估大型卫生系统中阿片类药物逐渐减少的安全性和有效性

基本信息

批准号：
10250728
负责人：
Ingrid A Binswanger
金额：
$ 16.32万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-15 至 2022-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10250728
关键词：
Address Buprenorphine COVID-19 COVID-19 pandemic COVID-19 testing Caring Chronic Clinic Clinical Colorado Data Dose Effectiveness Electronic Health Record Employment Epidemiology Ethnic Origin Face Financial Hardship Gender Goals Harm Reduction Health Health Services Health Services Accessibility Health system Healthcare Individual Information Systems Interdisciplinary Study Intervention Lead Longitudinal cohort study Measures Medicine Naloxone Opioid Opioid Analgesics Outcome Overdose Pain Pain management Pathway interactions Patients Pattern Pharmaceutical Preparations Population Population Heterogeneity Positioning Attribute Primary Health Care Public Health Quarantine Race Research Risk Safety Services Social Distance Social isolation Sociology Suboxone Suspensions Time United States Viral Antibodies Vulnerable Populations Wisconsin Woman addiction antibody test barrier to care buprenorphine treatment care delivery care giving burden chronic pain cohort data infrastructure ethnic minority population experience health disparity improved interest opioid exposure opioid overdose opioid tapering opioid therapy opioid use disorder overdose risk pandemic disease parent grant patients who use opioids prescription opioid psychological distress public health emergency racial minority study population substance use substance use treatment surveillance data tool

项目摘要

PROJECT ABSTRACT The United States is confronting two concurrent public health emergencies of opioid overdoses and the coronavirus disease 2019 (COVID-19). The COVID-19 pandemic may contribute to increases in overdose through widespread disruptions of health services, which include services specific to patients with chronic opioid exposure, either prescribed or non-prescribed. Changes to care delivery implemented in health systems including suspension of non-critical services and clinic closures, along with public health measures such as social distancing and quarantine, can create barriers to timely care. Disruptions to care, such as opioid dose variability and discontinuation, may lead to adverse health outcomes, including opioid overdose. These impacts of the pandemic may be unevenly experienced across subpopulations, with potential to reinforce and exacerbate health disparities. The overall goal of this project is to conduct a longitudinal cohort study to examine potential disparate impacts on health and health services in large health systems. Our specific aims: (1) In patients prescribed long-term opioid therapy (LTOT), characterize changes in opioid analgesic and naloxone prescribing patterns, opioid dose variability and discontinuation, primary care utilization, and opioid overdose before and during the COVID-19 pandemic and COVID-19 testing by race/ethnicity and gender; and (2) In patients with opioid use disorder (OUD), characterize changes in buprenorphine treatment for OUD and naloxone prescribing patterns, addiction treatment utilization, and opioid overdose before and during the COVID-19 pandemic and COVID-19 testing by race/ethnicity and gender. We will leverage a data system developed in the parent grant (Pathways to Opioid Safety Datalink [POSD]) that contains data on more than 2.5 million people in Colorado and Wisconsin. We will examine changes in health services in cohorts of patients prescribed chronic opioid therapy and with an opioid use disorder (OUD) before and during the COVID-19 pandemic from 2019 to 2020. Our findings will inform strategies to address under-utilization of appropriate healthcare during the COVID-19 pandemic among vulnerable populations, including improved delivery of care, expanded access to harm reduction measures, and targeted COVID-19 testing.

项目摘要美国正在面对两种同时的阿片类药物过量的公共卫生紧急情况，冠状病毒疾病2019（Covid-19）。共同19-19大流行可能导致过量增加通过广泛的医疗服务中断，其中包括针对慢性患者的服务阿片类药物暴露，处方或未处方。在卫生系统中实施的护理交付的更改包括暂停非关键服务和诊所关闭，以及公共卫生措施社会疏远和隔离，可以为及时照顾而造成障碍。护理中断，例如阿片类药物剂量可变性和停药可能导致不良健康结果，包括阿片类药物过量。这些大流行的影响可能会在亚群中经历不均匀，并有可能加强和加剧健康差异。该项目的总体目标是进行纵向队列研究检查大型卫生系统中对健康和卫生服务的潜在不同影响。我们的具体目标：（1）在规定长期阿片类药物治疗（LTOT）的患者中，阿片类镇痛和纳洛酮处方模式，阿片类药物剂量变异性和停药，初级保健利用和阿片类药物通过种族/种族和性别，在19日大流行前后的大流行和共vid-19测试过量；和（2）在阿片类药物使用障碍（OUD）的患者中，丁丙诺啡治疗的OUD和纳洛酮的处方模式，成瘾治疗利用和阿片类药物过量之前和期间 COVID-19-19通过种族/种族和性别进行大流行和Covid-19测试。我们将利用数据系统在父母赠款（通往阿片类药物安全数据链接[POSD]的途径）中开发的，该数据包含的数据超过科罗拉多州和威斯康星州有250万人。我们将研究卫生服务的变化患者开出了慢性阿片类药物治疗，并在阿片类药物使用障碍（OUD）之前和期间使用 2019年至2020年，COVID-19-19 在脆弱人群中，在19日大流行期间的适当医疗保健，包括改善提供护理，扩大危害减少措施的机会以及针对性的COVID-19测试。