Prescribing of opioids at hospital discharge and associated adverse patient outcomes

出院时阿片类药物的处方和相关的不良患者结局

• 批准号: 10018914
• 负责人: Anupam Bapu Jena
• 金额: $ 37.5万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10018914
• 关键词: Prescribing; opioids; hospital; discharge; associated

Project Summary/Abstract The opioid addiction crisis in the US is increasingly affecting older adults. Hospitalization rates for opioid overdoses grew five-fold from 1993 to 2012 among older Medicare beneficiaries. High rates of prescription opioid use among older adults are particularly concerning given that adverse outcomes related to prescription opioid use - including falls, fractures, and all cause-mortality - are known to be greater in older adults. An important, common, and unstudied scenario for new opioid prescription is at the time of discharge from a medical hospitalization (e.g., non-surgical conditions such as pneumonia, heart failure, sepsis, delirium, etc.). Elderly patients who are hospitalized with medical conditions are at elevated risk of adverse outcomes related to opioid use not only due to clinical fragility but also fragmented transitions in care, which may make monitoring of opioids’ side effects by outpatient providers difficult. Yet, little data exist on the extent to which patients hospitalized for medical conditions are prescribed an opioid at time of discharge, the medical conditions for which prescribing is greatest, and the effects of these opioid prescriptions on adverse patient outcomes and long-term opioid dependence. It is also unknown how individual physicians and hospitals contribute to inappropriate prescription opioid use among patients hospitalized with general medical conditions, as well as the physician- and hospital-level factors that correlate with opioid prescribing. Variation in physician prescribing is thought to be an important driver of the opioid epidemic, in part because existing guidelines are underutilized, allowing for non-uniform prescribing to emerge. Differences in hospital prescribing cultures may also drive variation in prescription opioid use across hospitals. The proposed grant will provide national estimates of the rate of opioid prescribing following general medical hospitalizations in Medicare; identify conditions for which prescribing and opioid-related adverse events are most common; quantify patient, physician, and hospital risk-factors that are associated with opioid prescribing; and use novel quasi-experimental methods to determine the effects of provider (both physician hospital) opioid prescribing patterns on opioid-related adverse events and long-term opioid use. The proposed research will be the first to comprehensively study how a single hospitalization can precipitate opioid-related adverse outcomes and long-term opioid dependence. The study’s findings will help policymakers and clinicians define the risks of transition to long-term opioid use and opioid-related adverse events in the post-hospitalization setting and will help inform targeted opioid policy to help elderly patients avoid opioid-related adverse consequences and dependency. The project will build a data infrastructure that allows for up-to-date data access, ensuring that the project’s findings are relevant to the current clinical practice and opioid policy.

项目概要/摘要 美国的阿片类药物成瘾危机日益影响老年人的阿片类药物住院率。 从 1993 年到 2012 年，老年医疗保险受益人的药物过量增加了五倍 高处方率。 鉴于与处方相关的不良后果，老年人中阿片类药物的使用尤其令人担忧 众所周知，阿片类药物的使用（包括跌倒、骨折和全因死亡）在老年人中较多。 新阿片类药物处方的一个重要、常见且未经研究的情况是在出院时 住院治疗（例如非手术病症，如肺炎、心力衰竭、败血症、谵妄等）。 因健康状况住院的老年患者发生相关不良后果的风险较高 阿片类药物的使用不仅是由于临床脆弱性，而且是由于护理中的零散过渡，这可能会使 然而，门诊提供者很难监测阿片类药物的副作用。 因医疗状况住院的患者在出院时会被开出阿片类药物，医疗机构 处方最多的情况，以及这些阿片类药物处方对不良患者的影响 结果和长期阿片类药物依赖。 目前还不清楚个别医生和医院如何导致不适当的处方阿片类药物 在患有一般疾病的住院患者以及医生和医院层面使用 与阿片类药物处方相关的因素被认为是医生处方的一个重要因素。 阿片类药物流行的驱动因素，部分原因是现有指南未得到充分利用，导致不统一 医院处方文化的差异也可能导致处方的变化。 医院内阿片类药物的使用。 拟议的赠款将提供对阿片类药物处方率的全国估计，遵循一般规定 医疗保险中的医疗住院；确定处方和阿片类药物相关不良的情况； 事件是最常见的；量化与阿片类药物相关的患者、医生和医院风险因素 开处方；并使用新颖的准实验方法来确定提供者（医生和医生）的效果 医院）阿片类药物处方模式对阿片类药物相关不良事件和长期阿片类药物使用的影响。 拟议的研究将是第一个全面研究单次住院治疗如何影响患者健康的研究。 该研究的结果将有助于促进与阿片类药物相关的不良后果和长期阿片类药物依赖。 政策制定者和参议员定义了长期使用阿片类药物的风险以及与阿片类药物相关的不良反应 住院后环境中的事件，并将有助于制定有针对性的阿片类药物政策，以帮助老年患者 避免与阿片类药物相关的不良后果和依赖性。该项目将构建一个数据基础设施。 允许访问最新数据，确保项目的研究结果与当前的临床相关 实践和阿片类药物政策。