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- Adverse Drug Events (ADE) (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 7 of 7 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
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)
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
Cook RR, Torralva R, King C
Associations between fentanyl use and initiation, persistence, and retention on medications for opioid use disorder among people living with uncontrolled HIV disease.
This study examined the associations between fentanyl use and initiation, persistence, and retention on medications for opioid use disorder (OUD) among people living with uncontrolled HIV disease. Data from a multisite clinical trial was used to compare extended-release naltrexone (XR-NTX) with treatment as usual (TAU: buprenorphine or methadone) to achieve HIV viral suppression among people with OUD and uncontrolled HIV disease. Exposure to fentanyl use was measured by urine drug screening. The cohort was 11 participants had an average age of 47 years, were 62% male, 57% Black and 13% Hispanic. Baseline fentanyl use was 64% for participants. Participants with baseline fentanyl use were 11 times less likely to initiative XR-NTX than those negative for fentanyl, but there was no evidence that fentanyl use impacted the likelihood of TAU initiation.
AHRQ-funded; HS026370.
Citation: Cook RR, Torralva R, King C .
Associations between fentanyl use and initiation, persistence, and retention on medications for opioid use disorder among people living with uncontrolled HIV disease.
Drug Alcohol Depend 2021 Nov 1;228:109077. doi: 10.1016/j.drugalcdep.2021.109077..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Human Immunodeficiency Virus (HIV), Chronic Conditions
Anderson KE, Alexander GC, Niles L
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
Investigators sought to measure quality of non-opioid use disorder (OUD) preventive and chronic illness care and care coordination for individuals with OUD compared with individuals without OUD. They used deidentified data on outpatients throughout the United States from claims for commercially insured and Medicare Advantage enrollees aged 18 years or older with diagnosis codes for OUD. They found that individuals with OUD have moderately lower quality of care across preventive and chronic illness care and care coordination for non-OUD care compared with individuals without OUD. They recommended more attention to measurement and improvement of non-OUD care for these individuals.
AHRQ-funded; HS000029.
Citation: Anderson KE, Alexander GC, Niles L .
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
JAMA Netw Open 2021 Apr;4(4):e214925. doi: 10.1001/jamanetworkopen.2021.4925..
Keywords: Opioids, Medication, Substance Abuse, Quality Indicators (QIs), Quality of Care, Behavioral Health, Chronic Conditions, Prevention
Wyse JJ, Lovejoy J, Holloway J
Patients' perceptions of the pathways linking chronic pain with problematic substance use.
This study examined how patients with chronic pain perceive their relationship between their substance use disorder (SUD) and chronic pain. About one-half of patients with SUDs experience chronic pain. The authors conducted qualitative interviews with 34 patients involved in SUD treatment who were also diagnosed with chronic pain. The interviews revealed 3 primary pathways. One group described SUD as development independently from their experiences of chronic pain. A second group described turning to substances to self-manage or cope with the chronic pain. A third group described encounters with opioid medications as the causal agent.
AHRQ-funded; HS026370.
Citation: Wyse JJ, Lovejoy J, Holloway J .
Patients' perceptions of the pathways linking chronic pain with problematic substance use.
Pain 2021 Mar;162(3):787-93. doi: 10.1097/j.pain.0000000000002077..
Keywords: Opioids, Substance Abuse, Medication, Pain, Chronic Conditions
Wyse J, Simmons A, Ramachandran B
"I don't mind doing what it takes to be safe." Patient perspectives of urine drug testing for pain.
This study sought to uncover patients’ beliefs regarding UDT and its implications for the patient–clinician relationship. Urine drug testing (UDT) is a standard recommendation for those prescribed long-term opioid therapy (LTOT) for pain but remains underutilized. Clinician fears regarding negative patient perceptions have been identified as a barrier to conducting UDT; however, little is known about patient perspectives of UDT.
AHRQ-funded; HS026370.
Citation: Wyse J, Simmons A, Ramachandran B .
"I don't mind doing what it takes to be safe." Patient perspectives of urine drug testing for pain.
J Gen Intern Med 2021 Jan;36(1):243-44. doi: 10.1007/s11606-020-05688-3..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Medication: Safety, Patient Safety, Substance Abuse