A Conceptual Framework for Understanding Unintended Prolonged Opioid Use
A Conceptual Framework for Understanding Unintended Prolonged Opioid Use
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DOI：
10.1016/j.mayocp.2017.10.010
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发表时间：
2017-12-01
影响因子：
8.9
通讯作者：
Warner, David O.
中科院分区：
文献类型：
--
作者：
Hooten, W. Michael;Brummett, Chad M.;Warner, David O.
迫切需要更好地了解从短期阿片类药物使用到非预期长期阿片类药物使用（UPOU）的过渡。这项工作的目的是提出一个概念框架来理解UPOU，该框架假定了3个主要领域的影响，包括（1）个体患者的特征，（2）实践环境，（3）阿片类药物处方者。虽然没有标准化的方法存在开发一个概念框架，该过程通常涉及确定确证证据，利用专家意见，以确定纳入框架的因素，并制定一个图形描述的各种因素和临床问题之间的关系的利益。可能与UPOU相关的关键患者特征包括（1）医学和精神健康状况;（2）疼痛病因;（3）对疼痛和阿片类药物的个体情感、行为和神经生理反应;（4）社会人口学因素。此外，UPOU可能受到结构和医疗保健政策因素的影响：（1）实践环境，包括处方临床医生的角色，采用相关的实践指南，以及临床医生的激励或抑制措施，以及（2）监管环境。最后，可能影响处方实践的临床医生固有特征包括（1）疼痛管理和阿片类药物使用的培训;（2）关于阿片类药物风险和益处的个人态度，知识和信念;（3）专业性。作为阿片类药物获取的守门人，处方临床医生的行为直接介导UPOU，3个域相互作用以确定此行为。这一拟议的概念框架可以指导未来关于这一主题的研究，并允许合理的基于假设的干预措施，以减少UPOU。(C)2017年马约医学教育和研究基金会
An urgent need exists to better understand the transition from short-term opioid use to unintended prolonged opioid use (UPOU). The purpose of this work is to propose a conceptual framework for understanding UPOU that posits the influence of 3 principal domains that include the characteristics of (1) individual patients, (2) the practice environment, and (3) opioid prescribers. Although no standardized method exists for developing a conceptual framework, the process often involves identifying corroborative evidence, leveraging expert opinion to identify factors for inclusion in the framework, and developing a graphic depiction of the relationships between the various factors and the clinical problem of interest. Key patient characteristics potentially associated with UPOU include (1) medical and mental health conditions; (2) pain etiology; (3) individual affective, behavioral, and neurophysiologic reactions to pain and opioids; and (4) sociodemographic factors. Also, UPOU could be influenced by structural and health care policy factors: (1) the practice environment, including the roles of prescribing clinicians, adoption of relevant practice guidelines, and clinician incentives or disincentives, and (2) the regulatory environment. Finally, characteristics inherent to clinicians that could influence prescribing practices include (1) training in pain management and opioid use; (2) personal attitudes, knowledge, and beliefs regarding the risks and benefits of opioids; and (3) professionalism. As the gatekeeper to opioid access, the behavior of prescribing clinicians directly mediates UPOU, with the 3 domains interacting to determine this behavior. This proposed conceptual framework could guide future research on the topic and allow plausible hypothesis-based interventions to reduce UPOU. (C) 2017 Mayo Foundation for Medical Education and Research