Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study.
Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study.
复制标题
优先设定疼痛管理的老年药物：疗养院利益相关者Delphi研究。
DOI：
10.1007/s40266-021-00836-8
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发表时间：
2021-04
期刊：
影响因子：
2.8
通讯作者：
Khodyakov D
中科院分区：
文献类型：
--
作者：
Lapane KL;Dubé C;Hume AL;Tjia J;Jesdale BM;Pawasauskas J;Khodyakov D
Evidence to guide clinical decision-making for pain management in nursing home residents is scant. To explore the existence of consensus regarding what analgesic issues should be prioritized for comparative effectiveness studies of beneficial and adverse effects of analgesic regimens in nursing home residents. Two stakeholder panels (nurses only, a mix of clinicians/researchers) were engaged (n=83). During a three-round online modified-Delphi process, participants rated and commented on the need for new evidence on non-opioid analgesic regimens, opioid regimens, short-term adverse effects, long-term adverse effects, short- or longer-term adverse effects, comorbid conditions, and other factors in the nursing home setting (9-point scale; 1=not essential to 9=very essential to obtain new evidence). The quantitative data were analyzed to determine the existence of consensus using an approached from the RAND/UCLA Appropriateness Method’s manual. The qualitative data consisting of participant explanations of their numeric ratings were thematically analyzed by a highly experienced qualitative researcher. For nursing home residents, evidence generation was deemed essential for: opioids, gabapentin (alone or with serotonin norepinephrine reuptake inhibitors (SNRIs)), and non-steroid anti-inflammatory medications with SNRIs. Experts prioritized the following outcomes as essential: long-term adverse effects including delirium, cognitive decline, and decline in activities of daily living (ADL). Kidney disease and depression were deemed essential conditions to consider in studies of pain medications. Co-prescribing analgesic regimens with benzodiazepines, sedating medications, and serotonergic medications, non-SNRI antidepressants were noted as essential areas of study. Experts noted that additional study was essential in residents with moderate/severe cognitive impairment and limitations in ADLs. Stakeholder priorities for more evidence reflect concerns related to treating medically complex residents with complex drug regimens and included long-term adverse effects, co-prescribing, and sedating medications. Carefully conducted observational studies are needed to address the vast evidence gap for nursing home residents.
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影响因子：
6.3
作者：
Khodyakov, Dmitry;Ochoa, Aileen;Briesacher, Becky
通讯作者：
Briesacher, Becky
影响因子：
4.7
作者：
Lapane, Kate L.;Quilliam, Brian J.;Kim, Myoung S.
通讯作者：
Kim, Myoung S.
DOI：
10.1093/gerona/glp019
发表时间：
2009-07-01
影响因子：
5.1
作者：
Berry, Sarah D.;Samelson, Elizabeth J.;Kiel, Douglas P.
通讯作者：
Kiel, Douglas P.
DOI：
10.1093/gerona/glw034
发表时间：
2016-09-01
影响因子：
5.1
作者：
Berry, Sarah D.;Lee, Yoojin;Mor, Vincent
通讯作者：
Mor, Vincent
影响因子：
4
作者：
Khodyakov D;Hempel S;Rubenstein L;Shekelle P;Foy R;Salem-Schatz S;O'Neill S;Danz M;Dalal S
通讯作者：
Dalal S