Undertreatment of Symptoms in Patients on Maintenance Hemodialysis
Undertreatment of Symptoms in Patients on Maintenance Hemodialysis
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DOI：
10.1016/j.jpainsymman.2009.07.003
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发表时间：
2010-02-01
影响因子：
4.7
通讯作者：
Holley, Jean L.
中科院分区：
文献类型：
--
作者：
Claxton, Rene N.;Blackhall, Leslie;Holley, Jean L.
上下文血液透析患者承受着巨大的症状负担，而对如何有效地治疗症状却知之甚少。为了评估血液透析患者可治疗症状的管理，我们对在美国大学接受门诊血液透析的患者进行了一项关于身体和情绪症状的30项问卷调查。我们询问患者是否为潜在可治疗的症状开了治疗处方，并评估了谁开了治疗处方。通过病历回顾，我们还记录了是否为这些疾病开了药。我们接触了87例患者，招募了62例（71%）。最常报告的潜在可治疗症状包括骨/关节疼痛、失眠、情绪障碍、性功能障碍、感觉异常和恶心。只有45%的骨/关节疼痛患者报告接受了镇痛药物治疗。23%的入睡困难患者和53%的恶心患者报告接受了缓解这种症状的药物治疗。图表审查显示，报告存在骨/关节疼痛的患者中有58%接受了止痛药治疗，23%的入睡困难患者接受了助眠药治疗，42%的恶心患者接受了止吐药治疗。初级保健提供者比肾脏科医生更有可能提供除恶心和麻木或脚刺痛以外的所有症状，并且这种差异在治疗担忧（3/3 vs. 0/3，P= 0.05）和紧张（4/5 vs. 0/5，P= 0.02）方面具有显著性。血液透析中潜在的可治疗症状治疗不足。药物治疗，特别是情绪症状，更常见于初级保健提供者比肾病学家。需要进一步研究症状治疗和干预措施的障碍，以增加肾病学家和初级保健提供者的症状管理。J Pain Symptom Manage 2010;39：211-218. 2010（C）美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
Context. Hemodialysis patients suffer a large symptom burden, and little is known about how effectively symptoms are treated.Objectives. To assess the management of treatable symptoms in hemodialysis patients, we administered a 30-item questionnaire on physical and emotional symptoms to patients receiving outpatient hemodialysis at the University of Virginia.Methods. We asked patients whether they were prescribed therapy for potentially treatable symptoms and assessed who prescribed the therapy. By means of chart review, we also documented whether medications were prescribed for these symptoms.Results. We approached 87 patients and enrolled 62 (71%). The most commonly reported, potentially treatable symptoms included bone/joint pain, insomnia, mood disturbance, sexual dysfunction, paresthesia, and nausea. Only 45% of patients with bone/joint pain reported receiving an analgesic medication. Twenty-three percent of patients with trouble falling asleep and 53% of patients with nausea reported receiving a medication to alleviate this symptom. Chart review revealed that 58% of patients who reported the presence of bone/joint pain were prescribed an analgesic, 23% of patients with trouble falling asleep were prescribed a sleep aid, and 42% of patients with nausea received an antiemetic. Primary care providers were more likely than nephrologists to provide for all symptoms except nausea and numbness or tingling in the feet, and this difference was significant for the treatment of worrying (3/3 vs. 0/3, P= 0.05) and nervousness (4/5 vs. 0/5, P= 0.02).Conclusion. Potentially treatable symptoms in hemodialysis are undertreated. Pharmacologic therapy, particularly for emotional symptoms, was more commonly prescribed by primary care providers than nephrologists. Additional study of the barriers to symptom treatment and interventions that increase nephrologist and primary care provider symptom management are needed. J Pain Symptom Manage 2010;39:211-218. 2010 (C) U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.