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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
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- (-) Chronic Conditions (8)
- Clinical Decision Support (CDS) (1)
- Elderly (4)
- Falls (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 8 of 8 Research Studies DisplayedCarlile N, Fuller TE, Benneyan JC
Lessons learned in implementing a chronic opioid therapy management system.
This article describes a research collaborative of health service researchers, systems engineers, and clinicians that sought to improve processes for safer chronic opioid therapy management in an academic primary care center. The authors present implementation results and lessons learned along with an intervention toolkit that others may consider using within their organization. They designed, tested, and implemented two key safe opioid use process metrics-percent for patients with recent opioid treatment agreements and urine drug tests. Focus groups were conducted after the conclusion of the implementation. They found a general lack of knowledge regarding resources available to patients and prescribers in the primary care clinic. In addition, 69% of clinicians reported largely “inheriting” (rather than initiating) their chronic opioid therapy patients. They also tracked 68 patients over a 4-year period and found although process measures improved, full adherence was not achieved for the entire population. Barriers identified included team structure, the evolving opioid environment, and surveillance challenges, along with disruptions resulting from the 2019 novel coronavirus.
AHRQ-funded; HS024453.
Citation: Carlile N, Fuller TE, Benneyan JC .
Lessons learned in implementing a chronic opioid therapy management system.
J Patient Saf 2022 Dec 1;18(8):e1142-e49. doi: 10.1097/pts.0000000000001039..
Keywords: Opioids, Medication, Pain, Chronic Conditions, Substance Abuse, Behavioral Health, Practice Patterns
Pritchard KT, Baillargeon J, Lee WC
Trends in the use of opioids vs nonpharmacologic treatments in adults with pain, 2011-2019.
This serial cross-sectional analysis on trends in the use of prescription opioids and nonpharmacologic alternatives in treating pain used MEPS to estimate the use of outpatient services by cancer-free adults with chronic or surgical pain from 2011 to 2019. A total of unweighted 46,420 respondents, 9643 (20.4% weighted) received surgery and 36,777 (79.6% weighted) did not. The prevalence of nonpharmacologic treatments increased in 2019 for both chronic and surgical pain cohorts, especially with exclusive use compared with 2011. Chiropractors and physical therapists were the most common licensed healthcare professionals used among the cohort who used nonpharmacologic treatment.
AHRQ-funded; T32HS026133.
Citation: Pritchard KT, Baillargeon J, Lee WC .
Trends in the use of opioids vs nonpharmacologic treatments in adults with pain, 2011-2019.
JAMA Netw Open 2022 Nov;5(11):e2240612. doi: 10.1001/jamanetworkopen.2022.40612..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Medication, Pain, Chronic Conditions, Treatments
Kagarmanova A, Sparkman H, Laiteerapong N
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
This article describes a protocol for an upcoming study on the planned implementation and evaluation of I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO®) to improve care for older adults with chronic pain, opioid use, and opioid use disorder (OUD). The study will be implemented in 35 clinical sites across the metropolitan Chicago area for patients aged ≥ 65 with chronic pain, opioid use, or OUD who receive primary care at one of the clinics. I-COPE includes the integration of patient-reported data on symptoms and preferences, clinical decision support tools and shared decision making into routine primary care. Primary care providers will be trained on the tools through web-based videos and an optional Project ECHO® course, entitled "Pain Management and OUD in Older Adults." A framework called RE-AIM will be used to assess the I-COPE implementation. Outcomes considered effective include an increased variety of recommended pain treatments, decreased prescriptions of higher-risk pain treatments, and decreased patient pain scores. Outcomes will be evaluated at 6 and 12 months after implementation, and PCPs participating in Project ECHO® will be evaluated on changes in knowledge, attitudes, and self-efficacy using pre- and post-course surveys.
AHRQ-funded; HS027910.
Citation: Kagarmanova A, Sparkman H, Laiteerapong N .
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
Trials 2022 Jul 27;23(1):602. doi: 10.1186/s13063-022-06537-w..
Keywords: Elderly, Pain, Chronic Conditions, Opioids, Medication, Substance Abuse, Behavioral Health, Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT)
Chen C, Lo-Ciganic WH, Winterstein AG
Concurrent use of prescription opioids and gabapentinoids in older adults.
This cross-sectional study investigated concurrent opioid-gabapentinoid use among older Medicare opioid users with chronic noncancer pain. The study found 464,732 eligible older beneficiaries aged 65 and older who filled ≥1 opioid prescription within 3 months after a randomly selected chronic noncancer pain diagnosis in a calendar year between 2011 and 2018. The prevalence of concurrent use increased from 17% in 2011 to 23.5% in 2013. The profile of concurrent users tended to be non-Black, low-income subsidy recipients, and Southern residents.
AHRQ-funded; HS027230.
Citation: Chen C, Lo-Ciganic WH, Winterstein AG .
Concurrent use of prescription opioids and gabapentinoids in older adults.
Am J Prev Med 2022 Apr;62(4):519-28. doi: 10.1016/j.amepre.2021.08.024..
Keywords: Elderly, Medication, Opioids, Pain, Chronic Conditions
Chen C, Winterstein AG, Lo-Ciganic WH
Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.
This study compared the risk of fall-related injury in two cohorts who used gabapentinoids concurrently with opioid use and those who used opioids only. The authors created 2 cohorts based on whether concurrent users initiated gabapentinoids on the day of opioid initiation (Cohort 1) or after opioid initiation (Cohort 2). Both cohorts were identified from a sample of older Medicare beneficiaries with chronic non-cancer pain (CNCP). Four concurrent users were matched up with 1 opioid-only user. They identified 6,733 concurrent users and 27,092 matched opioid-only users in Cohort 1 and 5,709 concurrent users and 22,388 matched opioid-only users in Cohort 2. Cohort 1’s incidence rate of fall-related injury was 24.5 per 100 person-users during follow-up and was 18.0 per 100-person-years during follow-up for Cohort 2. Concurrent users had had similar risk of fall-related injury as opioid-only users in Cohort 1 but had higher risk for fall-related injury than opioid-only users in Cohort 2.
AHRQ-funded; HS027230.
Citation: Chen C, Winterstein AG, Lo-Ciganic WH .
Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.
PLoS Med 2022 Mar;19(3):e1003921. doi: 10.1371/journal.pmed.1003921..
Keywords: Elderly, Opioids, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Falls, Patient Safety, Injuries and Wounds, Pain, Chronic Conditions
Encinosa W, Bernard D, Selden TM
AHRQ Author: Encinosa W, Bernard D, Selden TM
Opioid and non-opioid analgesic prescribing before and after the CDC's 2016 opioid guideline.
This study examined opioid and non-opioid prescribing before and after the issuing of CDC’s 2016 opioid guideline. The authors developed a theory of physician prescribing behavior under the CDC’s two-pronged incentive structure. They used MEPS survey data to empirically corroborate the theory that the regulations and guidelines have the intended effects of reducing opioid prescriptions for acute and chronic pain, as well as the predicted unintended effects-income effects cause regulations on acute pain treatment to increase chronic pain opioid prescriptions and the chronic pain treatment guidelines spillover to reduce opioids for acute pain. They also found that the guidelines work as intended in terms of the reduced usage, with chronic pain patients shifting to non-opioids and tapering off opioid doses.
AHRQ-authored.
Citation: Encinosa W, Bernard D, Selden TM .
Opioid and non-opioid analgesic prescribing before and after the CDC's 2016 opioid guideline.
Int J Health Econ Manag 2022 Mar;22(1):1-52. doi: 10.1007/s10754-021-09307-4..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Practice Patterns, Medication, Pain, Chronic Conditions
Wei YJ, Chen C, Lewis MO
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study used a sample of older patients who are Medicare beneficiaries who were newly prescribed opioids to determine rates of 4 prescription opioid dose trajectories and the risk of opioid-related adverse events (ORAEs). A 5% random sample of Medicare beneficiaries from 2011 to 2018 was used to conduct a nested case-control study of patients age 65 and older who were newly diagnosed with chronic noncancer pain (CNCP). Among the cases and controls, 2,192 (70.6%) were women and mean age was 77.1 years. Four prescribed opioid trajectories before the incident ORAE diagnosis or matched date emerged: gradual dose discontinuation (from ≤3 to 0 daily morphine milligram equivalent (MME), 1,456 [23.5%]), gradual dose increase (from 0 to >3 daily MME, 1,878 [30.3%]), consistent low dose (between 3 and 5 daily MME, 1,510 [24.3%]), and consistent moderate dose (>20 daily MME, 1,362 [22.0%]). Less than 5% were prescribed a mean daily dose of ≥90 daily MME during 6 months before diagnosis or matched date. Patients with gradual dose discontinuation versus those with a consistent low or moderate dose, and increase dose were more likely to be 65 to 74 years, Midwest US residents, and receiving no low-income subsidy. Those with gradual dose increase and consistent moderate dose had a higher risk of ORAE, after adjustment for covariates.
AHRQ-funded; HS027230.
Citation: Wei YJ, Chen C, Lewis MO .
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
PLoS Med 2022 Mar;19(3):e1003947. doi: 10.1371/journal.pmed.1003947..
Keywords: Elderly, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Chronic Conditions, Pain, Substance Abuse, Behavioral Health, Medication: Safety, Patient Safety
White AEC, Hood-Medland EA, Kravitz RL
Visit linearity in primary care visits for patients with chronic pain on long-term opioid therapy.
Physicians and patients report frustration after primary care visits for chronic pain. The need to shift between multiple clinical topics to address competing demands during visits may contribute to this frustration. This study created a novel measure, "visit linearity," to assess visit organization and examined whether visits that required less shifting back and forth between topics were associated with better patient and physician visit experiences.
AHRQ-funded; HS022236.
Citation: White AEC, Hood-Medland EA, Kravitz RL .
Visit linearity in primary care visits for patients with chronic pain on long-term opioid therapy.
J Gen Intern Med 2022 Jan;37(1):78-86. doi: 10.1007/s11606-021-06917-z..
Keywords: Opioids, Pain, Chronic Conditions, Primary Care, Medication