Advancing a National Agenda to Eliminate Disparities in Pain Care: Directions for Health Policy, Education, Practice, and Research
Advancing a National Agenda to Eliminate Disparities in Pain Care: Directions for Health Policy, Education, Practice, and Research
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DOI：
10.1111/j.1526-4637.2011.01289.x
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发表时间：
2012-01-01
期刊：
影响因子：
3.1
通讯作者：
Gallagher, Rollin M.
中科院分区：
文献类型：
--
作者：
Meghani, Salimah H.;Polomano, Rosemary C.;Gallagher, Rollin M.
背景。疼痛与巨大的个人和社会成本密切相关。任何关于疼痛的倡议的一个关键因素必须集中在消除疼痛护理的不平等，这种不平等在美国医疗保健机构中普遍存在。本报告关注与美国疼痛护理差异相关的宏观因素，这些因素可能需要政策干预。我们确定具体的机会，以实现公平的疼痛护理，特别是那些由最近的立法变化引起的美国医疗保健系统。积极的政策、倡导和研究议程综合在五个领域：1)结构/系统；2)政策与倡导；3)员工;4)供应商;5)研究结果。疼痛治疗中的不公平仍然是一个重要的、被忽视的卫生政策问题。《平价医疗法案》（ACA）中的许多直接和间接条款以及其他利用ACA的国家举措提供了实现疼痛护理公平的机会。这些变化包括保险、公共、提供者和立法教育、初级保健和疼痛专家培训、提高劳动力多样性、实现种族/民族数据收集的一致性、强调以患者为中心的结果研究，以及鼓励在比较有效性研究范式中关注疼痛护理的差异。ACA内最近的国家立法倡议预计将产生多层次的努力，这将影响资金的流动，以解决普遍存在的差距问题。现在是疼痛社区带头实施疼痛护理差异协调议程的好时机，以便利用这些国家倡议。
Background. Pain is strongly associated with significant personal and societal costs. A crucial element of any initiative on pain must focus on eliminating pain care disparities that are pervasive throughout the United States health care settings.Objectives. This report focuses on macro-level factors related to pain care disparities in the United States that may be amenable to policy interventions.Methods. We identify concrete opportunities for achieving equity in pain care, especially those occasioned by recent legislative changes in the United States health care system. An aggressive policy, advocacy, and research agenda is synthesized in five domains: 1) structural/system; 2) policy and advocacy; 3) workforce; 4) provider; and 5) research.Results. Inequities in pain care remain an important and neglected health policy concern. Many direct and indirect provisions within the Affordable Care Act (ACA) and other national initiatives that leverage on ACA offer opportunities to achieve equity in pain care. These include changes in insurance, in public, provider, and legislative education, in primary care and pain specialist training, improving workforce diversity, achieving uniformity in race/ethnicity data collection, emphasizing patient-centered outcomes research, and encouraging focus on pain care disparities within the comparative effectiveness research paradigm.Conclusions. Recent national legislative initiatives within ACA are expected to generate multilevel efforts that will impact the flow of funding to address the pervasive issue of disparities. It is an opportune time for the pain community to take a lead in implementing a concerted agenda on pain care disparities in order to leverage these national initiatives.