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Bérubé M, Dupuis S, Leduc S, Roy I, Côté C, Grzelak S, Clairoux S, Panic S, Lauzier F. Tapering Opioid Prescription Program for High-Risk Trauma Patients: A Pilot Randomized Controlled Trial. Pain Manag Nurs 2021; 23:142-150. [PMID: 34479822 DOI: 10.1016/j.pmn.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic opioid use has been documented in up to 20% of patients with traumatic injuries. Hence, we developed the Tapering Opioids Prescription Program for high-risk Trauma (TOPP-Trauma) patients. AIMS To assess the feasibility and acceptability of TOPP-Trauma, examine the feasibility of the research methods, and describe its potential efficacy in reducing long-term opioid use. DESIGN A two-arm pilot randomized controlled trial. METHODS Fifty participants discharged home were assigned to TOPP-Trauma or an educational pamphlet. Feasibility was assessed based on ability to provide the program components. The acceptability was assessed with the Treatment Acceptability and Preference Questionnaire. The feasibility of the research methods was evaluated according to standard parameters. Self-reported morphine equivalent dose (MED) and MEDs supplied by pharmacies were measured at 6 and 12 weeks. RESULTS Eighty percent or more of TOPP-Trauma components were delivered as planned, and the program was deemed highly acceptable. Approximately 10% of screened patients were eligible. Eighty-five percent of eligible patients agreed to participate with 20% attrition rates. TOPP-Trauma participants used less MED/day compared to the control group at 6 and 12 weeks (1.2. vs. 12.2 mg; 0.4. vs 4.0 mg), and pharmacies supplied less than half of cumulative MEDs to those who received the program at 12 weeks, but the differences were not statistically significant. CONCLUSIONS Some challenges need to be addressed before testing TOPP-Trauma. These include creating strategies to decrease attrition, offering the program throughout the care continuum to higher risk patients, and evaluating the impacts of reduced opioid use.
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Affiliation(s)
- Mélanie Bérubé
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada; Faculty of Nursing, Université Laval, Quebec City, Canada.
| | - Sébastien Dupuis
- Pharmacy Department, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
| | - Stéphane Leduc
- Orthopaedic Department, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
| | - Isabel Roy
- Trauma Program, Hôpital du Sacré-Cœur de Montréal, 5400 Boulevard Gouin, Monteal, Canada
| | - Caroline Côté
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada; Faculty of Nursing, Université Laval, Quebec City, Canada
| | - Sonia Grzelak
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada; Faculty of Nursing, Université Laval, Quebec City, Canada
| | - Sarah Clairoux
- Pharmacy Department, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
| | - Stéphane Panic
- Trauma Program, Hôpital du Sacré-Cœur de Montréal, 5400 Boulevard Gouin, Monteal, Canada
| | - François Lauzier
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada
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Bérubé M, Deslauriers V, Leduc S, Turcotte V, Dupuis S, Roy I, Clairoux S, Panic S, Nolet M. Feasibility of a tapering opioids prescription program for trauma patients at high risk of chronic consumption (TOPP-trauma): protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2019; 5:67. [PMID: 31110776 PMCID: PMC6511175 DOI: 10.1186/s40814-019-0444-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/09/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD) and deaths related to the chronic use of opioids have increased significantly over the last two decades. Chronic consumption of opioids has been documented in many patients with traumatic injuries. Preliminary research findings have shown that interventions using cognitive-behavioral strategies were a promising adjunct in decreasing the burden associated with opioid consumption. Accordingly, the Tapering Opioids Prescription Program in Trauma (TOPP-Trauma) was developed. PURPOSE To assess the feasibility of the TOPP-Trauma intervention and its research methods; and explore the potential efficacy of TOPP-Trauma in reducing opioid consumption. METHODS A 2-arm pilot randomized controlled trial (RCT) will be conducted in patients presenting a high risk for chronic opioid consumption. Fifty participants at high risk for chronic consumption of opioid will receive either TOPP-Trauma or an educational pamphlet. The feasibility assessment of TOPP-Trauma will be based on the ability to provide its components as initially planned. Several parameters will be evaluated to determine the feasibility of the research methods, including the adequacy of the sampling pool, the dropout rate, and the ease of data collection. The morphine equivalent dose (MED) per day between both groups will be measured at 6 and 12 weeks. Pain intensity and pain interference with activities will also be evaluated at the same time points. DISCUSSION This study will provide evidence on the feasibility of a preventive program aimed at reducing chronic opioid use in high risk trauma patients. Information will also be gathered on the methods that should be used to test the efficacy of such programs. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 40263056. Registered 26 May 2018.
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Affiliation(s)
- M. Bérubé
- Faculty of Nursing, Laval University, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6 Canada
- Research Center, CHU de Québec, Quebec City, QC Canada
| | - V. Deslauriers
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC Canada
| | - S. Leduc
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
| | - V. Turcotte
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
| | - S. Dupuis
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC Canada
| | - I. Roy
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
| | - S. Clairoux
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC Canada
| | - S. Panic
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
| | - M. Nolet
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
- Department of Anesthesiology, Faculty of Medicine, Université de Montreal, Montreal, QC Canada
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Mavrakanas TA, Fournier MA, Clairoux S, Amiel JA, Tremblay ME, Vinh DC, Coursol C, Thirion DJG, Cantarovich M. Neutropenia in kidney and liver transplant recipients: Risk factors and outcomes. Clin Transplant 2017; 31. [PMID: 28736953 DOI: 10.1111/ctr.13058] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 12/17/2022]
Abstract
No studies have directly compared the key characteristics and outcomes of kidney (KTx) and liver transplantation (LTx) recipients with neutropenia. In this single-center, retrospective, cohort study, we enrolled all adult patients who received a KTx or LTx between 2000 and 2011. Neutropenia was defined as 2 consecutive absolute neutrophil count (ANC) values <1500/mm3 in patients without preexisting neutropenia. The first neutropenia episode occurring during the first year post-transplantation was analyzed. A total of 663 patients with KTx and 354 patients with LTx met the inclusion criteria. Incidence of neutropenia was 20% in KTx and 38% in LTx, respectively. High-risk CMV status and valganciclovir (VGCV) use were significant predictors of neutropenia for KTx recipients, but only VGCV use vs nonuse in LTx recipients. Neutropenia was associated with worse survival in KTx recipients (adjusted HR 1.95, 95% CI 1.18-3.22, P<.01), but not in LTx recipients (adjusted HR 0.75, 95% CI 0.52-1.10, P=.15). Sixteen acute rejection episodes were associated with preceding neutropenia in KTx recipients (HR 1.77, 95% CI 1.16-2.68, P=.007) and 24 acute rejection episodes in LTx recipients (HR 1.41, 95% CI 0.97-2.04, P=.07). Incidence of infection was similar in patients with and without neutropenia among KTx and LTx recipients.
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Affiliation(s)
- Thomas A Mavrakanas
- Division of Nephrology, Department of Medicine, Multi-Organ Transplant Program, McGill University Health Center, Montreal, QC, Canada
| | - Marie-Andrée Fournier
- Department of Pharmacy, University of Montreal Hospital Centre, Montreal, QC, Canada.,Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
| | - Sarah Clairoux
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.,Department of Pharmacy, McGill University Health Center, Montreal, QC, Canada.,Department of Pharmacy, Sacré-Coeur Hospital, Montreal, QC, Canada
| | - Jacques-Alexandre Amiel
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.,Department of Pharmacy, McGill University Health Center, Montreal, QC, Canada
| | | | - Donald C Vinh
- Division of Infectious Diseases, McGill University Health Center, Montreal, QC, Canada
| | - Christian Coursol
- Department of Pharmacy, McGill University Health Center, Montreal, QC, Canada
| | - Daniel J G Thirion
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.,Department of Pharmacy, McGill University Health Center, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Division of Nephrology, Department of Medicine, Multi-Organ Transplant Program, McGill University Health Center, Montreal, QC, Canada
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