Meeting high-risk patient pain care needs through intensive primary care: a secondary analysis.
Meeting high-risk patient pain care needs through intensive primary care: a secondary analysis.
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DOI：
10.1136/bmjopen-2023-080748
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发表时间：
2024-01-02
期刊：
影响因子：
2.9
通讯作者：
中科院分区：
文献类型：
--
作者：
慢性疼痛不成比例地影响医学和心理社会复杂的患者，其中许多人处于住院的高风险中。然而，高风险患者的疼痛患病率尚不清楚，疼痛很少是改善高风险患者结局的重点。我们的目标是（1）评估高风险患者人群的疼痛频率，（2）确定患者和提供者认为在基于初级保健（PC）的IM中促进以患者为中心的疼痛护理的重要强化管理（IM）计划功能。对高危患者多中心随机化基于PC的IM项目的定量和定性评价数据进行次要观察分析。五个整合的地方退伍军人事务部（VA）医疗保健系统在不同的VA行政区域。VA的工作人员和高风险PC患者。一项针对高危患者的多中心随机化基于PC的IM计划。(a)疼痛患病率基于VA电子管理数据和（B）与IM工作人员和提及疼痛的患者的访谈记录。大多数（70%，2593/3723）高风险患者至少有中度疼痛。超过三分之一（38%，40/104）的受访者提到疼痛或疼痛护理。在40份访谈记录中，有89条与疼痛相关的评论涉及IM对疼痛护理的影响。患者确定的主题是IM改善了沟通和对疼痛的反应。PC提供商确定的主题是，IM改善了工作量和获得专业知识。IM团队成员确定的主题是IM改善疼痛护理协调，促进非阿片类药物疼痛管理选择，减轻提供者同情疲劳。没有提到IM对疼痛护理的负面影响。疼痛在高危患者中很常见。未来的IM评估应考虑包括对疼痛和疼痛护理的关注，并注意对患者、PC提供者和IM团队的影响。
Chronic pain disproportionately affects medically and psychosocially complex patients, many of whom are at high risk of hospitalisation. Pain prevalence among high-risk patients, however, is unknown, and pain is seldom a focus for improving high-risk patient outcomes. Our objective is to (1) evaluate pain frequency in a high-risk patient population and (2) identify intensive management (IM) programme features that patients and providers perceive as important for promoting patient-centred pain care within primary care (PC)-based IM. Secondary observational analysis of quantitative and qualitative evaluation data from a multisite randomised PC-based IM programme for high-risk patients. Five integrated local Veterans Affairs (VA) healthcare systems within distinct VA administrative regions. Staff and high-risk PC patients in the VA. A multisite randomised PC-based IM programme for high-risk patients. (a) Pain prevalence based on VA electronic administrative data and (b) transcripts of interviews with IM staff and patients that mentioned pain. Most (70%, 2593/3723) high-risk patients had at least moderate pain. Over one-third (38%, 40/104) of the interviewees mentioned pain or pain care. There were 89 pain-related comments addressing IM impacts on pain care within the 40 interview transcripts. Patient-identified themes were that IM improved communication and responsiveness to pain. PC provider-identified themes were that IM improved workload and access to expertise. IM team member-identified themes were that IM improved pain care coordination, facilitated non-opioid pain management options and mitigated provider compassion fatigue. No negative IM impacts on pain care were mentioned. Pain is common among high-risk patients. Future IM evaluations should consider including a focus on pain and pain care, with attention to impacts on patients, PC providers and IM teams.
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影响因子：
2.9
作者：
Harle CA;Bauer SE;Hoang HQ;Cook RL;Hurley RW;Fillingim RB
通讯作者：
Fillingim RB
影响因子：
16.4
作者：
Gatchel, Robert J.;McGeary, Donald D.;Lippe, Ben
通讯作者：
Lippe, Ben
影响因子：
9.7
作者：
Bates, David W.;Saria, Suchi;Escobar, Gabriel
通讯作者：
Escobar, Gabriel
影响因子：
13.8
作者：
Chang, Evelyn T.;Zulman, Donna M.;Rubenstein, Lisa, V
通讯作者：
Rubenstein, Lisa, V
DOI：
10.1016/j.hjdsi.2017.10.001
发表时间：
2018-12-01
影响因子：
2.5
作者：
Chang, Evelyn T.;Raja, Pushpa, V;Asch, Steven M.
通讯作者：
Asch, Steven M.