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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (2)
- Back Health and Pain (1)
- Behavioral Health (2)
- Care Management (2)
- Chronic Conditions (6)
- Clinical Decision Support (CDS) (1)
- Comparative Effectiveness (1)
- Decision Making (1)
- (-) Elderly (9)
- Falls (1)
- Health Information Technology (HIT) (1)
- Home Healthcare (1)
- Injuries and Wounds (1)
- Long-Term Care (2)
- Medication (7)
- Medication: Safety (2)
- Nursing Homes (2)
- Opioids (6)
- (-) Pain (9)
- Patient Safety (2)
- Patient Self-Management (1)
- Practice Patterns (3)
- Risk (1)
- Substance Abuse (2)
- Surgery (1)
- Treatments (1)
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 9 of 9 Research Studies DisplayedBongiovanni T, Gan S, Finlayson E
Prolonged use of newly prescribed gabapentin after surgery.
This study investigated postoperative prolonged gabapentin use in adults 65 years and older. The authors merged a 20% sample of Medicare Carrier, MedPAR, and Outpatient Files with Part D for 2013-2018. They defined new postoperative gabapentin as fills for 7 days before surgery until 7 days after discharge. Overall, 3% of all eligible patients (n = 17,970) had a new prescription for gabapentin postsurgery. Out of those, the mean age was 73 years old and 62% were female. The most common surgeries that gabapentin was prescribed for was total knee (45%) and total hip (21%) replacements. Prolonged use occurred in 22% of patients, with women, non-White, those with concurrent prolonged opioid use, and patients having undergone emergency surgery more likely to have prolonged use.
Citation: Bongiovanni T, Gan S, Finlayson E .
Prolonged use of newly prescribed gabapentin after surgery.
J Am Geriatr Soc 2022 Dec;70(12):3560-69. doi: 10.1111/jgs.18005..
Keywords: Medication, Surgery, Pain, Elderly, Practice Patterns
Curatolo M, Rundell SD, Gold LS
Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults.
The purpose of this prospective study was to compare older adults undergoing epidural steroid injections (ESI) with patients not receiving ESI to test the hypotheses that those on ESI: 1) have worse outcomes before ESI, 2) have improved outcomes after ESI, and 3) have improved outcomes due to a specific ESI effect. The researchers evaluated patients 65 years of age or older from 3 United States health care systems who presented to primary care with new episodes of back pain. The three outcomes assessed were back and leg pain intensity, disability, and quality of life, all of which were evaluated at baseline, and then with 3-, 6-, 12- and 24- month follow-ups. The study found that in ESI patients, pain intensity, disability, and quality of life at baseline were significantly worse than in non-ESI patients. The study concluded that adults 65 and older who were treated with ESI have long-term improvement, but the improvement is not likely to be related to a specific effect of ESI, making epidural steroid injections unlikely to provide long-term benefits.
AHRQ-funded; HS019222; HS022972.
Citation: Curatolo M, Rundell SD, Gold LS .
Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults.
Eur J Pain 2022 Aug;26(7):1469-80. doi: 10.1002/ejp.1975..
Keywords: Elderly, Back Health and Pain, Pain, 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), 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
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
Reid MC, Henderson CR, Jr., Trachtenberg MA
Implementing a pain self-management protocol in home care: a cluster-randomized pragmatic trial.
The researchers sought to determine the effectiveness of a cognitive-behavioral pain self-management protocol delivered by physical therapists for use by older adults with activity-limiting pain receiving home care. Their real-world pragmatic trial found no effect of implementation of a pain self-management intervention in a home care setting.
AHRQ-funded; HS020648.
Citation: Reid MC, Henderson CR, Jr., Trachtenberg MA .
Implementing a pain self-management protocol in home care: a cluster-randomized pragmatic trial.
J Am Geriatr Soc 2017 Aug;65(8):1667-75. doi: 10.1111/jgs.14836.
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Keywords: Home Healthcare, Patient Self-Management, Pain, Elderly, Comparative Effectiveness
Fain KM, Alexander GC, Dore DD
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
The purpose of this study was to quantify prescription analgesic use of elderly nursing home (NH) residents with persistent noncancer pain and to identify individual and facility traits associated with no treatment. The investigators concluded that through 2008, pain remained undertreated in NHs, especially in certain subpopulations, including cognitively impaired and older residents. The authors suggest that changes in pain management practice and policies may be necessary to target these vulnerable residents.
AHRQ-funded; HS022998.
Citation: Fain KM, Alexander GC, Dore DD .
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
J Am Geriatr Soc 2017 Feb;65(2):286-93. doi: 10.1111/jgs.14512..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Fain KM, Castillo-Salgado C, Dore DD
Inappropriate fentanyl prescribing among nursing home residents in the United States.
In this cross-sectional study, the investigators quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. The investigators concluded that most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. They suggest that changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
AHRQ-funded; HS018960.
Citation: Fain KM, Castillo-Salgado C, Dore DD .
Inappropriate fentanyl prescribing among nursing home residents in the United States.
J Am Med Dir Assoc 2017 Feb;18(2):138-44. doi: 10.1016/j.jamda.2016.08.015..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns