Predictors of acute care utilization and acute pain treatment outcomes in adults with sickle cell disease: The role of non-hematologic characteristics and baseline chronic opioid dose
Predictors of acute care utilization and acute pain treatment outcomes in adults with sickle cell disease: The role of non-hematologic characteristics and baseline chronic opioid dose
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DOI：
10.1002/ajh.25168
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发表时间：
2018-09-01
影响因子：
12.8
通讯作者：
Lanzkron, Sophie
中科院分区：
文献类型：
--
作者：
Carroll, C. Patrick;Cichowitz, Cody;Lanzkron, Sophie
尽管镰状细胞病在美国很少见，但它占医疗保健利用和成本的不成比例。其中大部分是由于对痛苦危机的紧急护理。由于经常去急诊室和急诊护理机构，一小部分患者承担了大部分费用。以前的研究发现，这些高利用率的患者的特点是更严重的疾病过程和某些非血液学特征，其中可能包括较高的社会经济地位和一些精神和心理特征。这项前瞻性观察性队列研究旨在测试这些特征前瞻性预测急性疼痛治疗结局的能力，包括约翰霍普金斯镰状细胞输注中心（SCIC）的访视频率、阿片类药物总剂量和疼痛改善。对73名参与者进行了12个月的随访，并对378次访视的SCIC利用率和治疗结局进行了制表。最常访问SCIC的参与者尽管访视内阿片类药物剂量较高，但疼痛改善明显更差。更高的利用率与疾病严重程度更高、镰状细胞病治疗更积极、基线阿片类药物剂量更高、社会经济地位更高、疼痛相关焦虑更严重和精神病治疗史等指标相关。总体而言，不良急性疼痛治疗反应与较高的利用率和较高的基线阿片类药物剂量相关。在先前的研究和未来的方向方面，讨论了高利用率，不良的急性护理结果和较高的基线阿片类药物剂量之间的关联模式。
Despite its rarity in the United States, sickle cell disease accounts for a disproportionate amount of healthcare utilization and costs. The majority of this is due to acute care for painful crises. A small subpopulation of patients accounts for most these costs due to frequent visits to emergency departments and acute care facilities. Previous investigations have found that these high utilizing patients are distinguished by both a more severe disease course and certain non-hematologic characteristics, which may include higher socioeconomic status and some psychiatric and psychological characteristics. This prospective observational cohort study was undertaken to test the ability of these characteristics to prospectively predict acute pain care outcomes, including visit frequency, total opioid doses, and pain improvement at the Johns Hopkins Sickle Cell Infusion Center (SCIC). Seventy-three participants were followed for 12 months and SCIC utilization and treatment outcomes were tabulated for 378 visits. Participants who visited the SCIC most frequently had markedly worse pain improvement despite higher within-visit opioid doses. Higher utilization was associated with indicators of greater illness severity, more aggressive treatment for sickle cell disease, higher baseline opioid doses, higher socioeconomic status, greater pain-related anxiety, and a history of psychiatric treatment. Overall, poor acute pain treatment response was associated with higher utilization and higher baseline opioid doses. The pattern of association between high utilization, poor acute care outcomes, and higher baseline opioid doses is discussed in terms of prior research and future directions.