Attitudes of Primary Care Practitioners in Managing Chronic Pain Patients Prescribed Opioids for Pain: A Prospective Longitudinal Controlled Trial
Attitudes of Primary Care Practitioners in Managing Chronic Pain Patients Prescribed Opioids for Pain: A Prospective Longitudinal Controlled Trial
复制标题
DOI：
10.1111/pme.12871
复制
发表时间：
2016-01-01
期刊：
影响因子：
3.1
通讯作者：
Ross, Edgar L.
中科院分区：
文献类型：
--
作者：
Jamison, Robert N.;Scanlan, Elizabeth;Ross, Edgar L.
客观的。初级保健医生 (PCP) 越来越担心慢性疼痛患者滥用阿片类药物治疗疼痛和不遵守药物治疗规定。本研究调查了旨在跟踪潜在阿片类药物滥用并通过使用风险评估、每月依从性监测和专业支持来提高从业者管理慢性疼痛患者的信心的干预措施的好处。方法。该研究招募了 56 名 PCP 和 253 名慢性疼痛患者。所有患者均接受风险评估，并在 6 个月内每月打电话一次，以监测疼痛和阿片类药物依从性。对从业人员对阿片类药物的了解、对镇痛处方的担忧、执业行为以及管理慢性疼痛患者的态度进行了评估，并在一年后重复问卷调查。实验组的从业者收到每月的患者总结报告，其中包括疼痛、情绪、活动水平、医疗保健利用率和阿片类药物依从性检查表的结果，而对照组的从业者没有收到每月的报告结果。一年后，所有 PCP 均报告在识别有误用风险的患者方面有所改善 (P < 0.05)，对开阿片类药物治疗疼痛的信心有所提高 (P < 0.05)，并且对与疼痛专家沟通的满意度有所提高 (P < 0.05)。患者报告称，他们对阿片类药物的依从性更高，并认为每月监测是有益的。尽管有所改善，但许多 PCP 仍然对管理疼痛患者缺乏信心，并表示不愿意开阿片类药物治疗慢性非癌性疼痛，尤其是年轻的从业者。这项研究证明了仔细监测慢性疼痛患者的好处以及初级保健中疼痛管理支持的需要。
Objective. There is increasing concern among primary care practitioners (PCPs) regarding medication misuse and noncompliance among chronic pain patients prescribed opioids for pain. This study investigated the benefits of interventions designed to track potential opioid misuse and to improve practitioner confidence in managing patients with chronic pain through the use of risk assessment, monthly monitoring of compliance, and specialty support.Methods. Fifty-six PCPs and 253 chronic pain patients were recruited into the study. All patients were assessed for risk and called once a month for 6 months to monitor pain and opioid compliance. Practitioner knowledge about opioids, concerns about analgesic prescriptions, practice behavior, and attitudes of managing chronic pain patients were assessed and questionnaires were repeated after 1 year. Practitioners in the experimental group received monthly patient summary reports that consisted of pain, mood, activity levels, healthcare utilization, and results of the Opioid Compliance Checklist, while practitioners in the control group did not receive the monthly reports.Results. After 1 year all the PCPs reported improvement in identifying patients at risk for misuse (P < 0.05), perceived confidence in prescribing opioids for pain (P < 0.05) and increased satisfaction with communication with pain specialists (P < 0.05). The patients reported greater compliance with their opioid medication and felt that the monthly monitoring was beneficial. Despite modest improvements, many PCPs still lacked confidence in managing pain patients and reported reluctance to prescribe opioids for chronic noncancer pain, especially among younger practitioners. This study demonstrates the benefits of careful monitoring of chronic pain patients and need for pain management support within primary care.