Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E, Clinical Sciences Building, 8440-112 St, Edmonton, NW, T6G 2B7, Canada.
School of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Syst Rev. 2019 Apr 5;8(1):88. doi: 10.1186/s13643-019-0997-5.
Opioids are routinely used to treat a variety of chronic conditions associated with pain. However, they are a class of medications with a significant potential for adverse health effects, with and without misuse. Opioid misuse, as defined as inappropriate use of appropriately prescribed opioids, is becoming more well-recognized publicly but does not have clear treatment options. Opioid misuse has been linked to variety of poor outcomes and its consequences have a significant impact on healthcare resource utilization. The evidence on harm reduction strategies to mitigate adverse events prompting presentation to acute care settings for patients presenting with long-term opioid use is sparse.
We will perform a systematic review and meta-analysis to catalog effective harm reduction strategies and identify the most effective ones to reduce avoidable healthcare utilization in patients on long-term opioid therapy who present to acute health care settings with complications attributed to opioid misuse. A search strategy will be developed and executed by an information specialist; electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) and additional sources will be searched. Search themes will include opioids, chronic drug use, and acute healthcare settings. Citation screening, selection, quality assessment, and data abstraction will be performed in duplicate. A comprehensive inventory of harm reduction strategies will be developed. Data will be collected on patient-related outcomes associated with each identified harm reduction strategy. When sufficiently homogeneous data on interventions, population, and outcomes is available, it will be pooled for aggregate analysis. Evaluation of the methodological quality of individual studies and of the quality of the body of evidence will be performed. Our primary objective will be to identify harm reduction strategies that have been shown to result in clinically relevant and statistically significant improvements in patient outcomes and/or decreased healthcare utilization.
This study will better characterize harm reduction strategies for patients on long-term prescribed opioids presenting to acute healthcare settings. It will also add new knowledge and generate greater understanding of key knowledge gaps of the long-term prescribed opioid use and its impact on healthcare utilization.
CRD42018088962 .
阿片类药物通常用于治疗各种与疼痛相关的慢性疾病。然而，它们是一类具有显著潜在不良健康影响的药物，无论是否存在滥用。阿片类药物滥用的定义为不恰当地使用适当开具的阿片类药物，目前已越来越受到公众的认可，但尚无明确的治疗选择。阿片类药物滥用与多种不良后果有关，其后果对医疗保健资源的利用有重大影响。关于减轻因长期使用阿片类药物而导致的不良事件导致患者到急性护理机构就诊的危害减少策略的证据很少。
我们将进行系统评价和荟萃分析，以编目有效的危害减少策略，并确定最有效的策略，以减少因阿片类药物滥用而导致并发症并到急性保健机构就诊的长期使用阿片类药物的患者的不必要的医疗保健利用。将由信息专家制定和执行搜索策略；将检索电子数据库（MEDLINE、EMBASE、CINAHL、Cochrane 图书馆）和其他来源。搜索主题将包括阿片类药物、慢性药物使用和急性医疗保健环境。将由两名研究人员进行重复的筛选、选择、质量评估和数据提取。将制定全面的危害减少策略清单。将收集与每个确定的危害减少策略相关的患者相关结果的数据。当有足够同质的干预措施、人群和结局数据时，将进行汇总分析。将评估单个研究的方法学质量和证据质量。我们的主要目标是确定已证明可导致患者结局的临床相关和统计学上显著改善和/或减少医疗保健利用的危害减少策略。
这项研究将更好地描述长期接受处方阿片类药物治疗并到急性保健机构就诊的患者的危害减少策略。它还将增加新知识，并更深入地了解长期处方阿片类药物使用及其对医疗保健利用的影响的关键知识空白。
CRD42018088962。
