Disease management for chronic pain: Barriers of program implementation with primary care physicians
Disease management for chronic pain: Barriers of program implementation with primary care physicians
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DOI：
10.1046/j.1526-4637.2002.02022.x
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发表时间：
2002-06-01
期刊：
影响因子：
3.1
通讯作者：
Fairchild, DG
中科院分区：
文献类型：
--
作者：
Jamison, RN;Gintner, L;Fairchild, DG
Objective.本研究调查了初级保健医生中慢性疼痛疾病管理（DM）计划的实施情况。其目的是传播慢性疼痛治疗指南，以帮助初级保健医生识别，治疗和管理疼痛严重受损的患者。该计划的目标是：1）确定那些疼痛患者谁是最大的残疾，由于疼痛; 2）评估的影响，糖尿病规划疼痛的临床实践;和3）评估的影响，该计划对医生的使用，遵守和满意度的指南。30名初级保健医生随访了82名被确定患有慢性偏头痛、背痛或疼痛性周围神经病变的患者。所有患者根据疼痛强度、活动干扰、情绪困扰、感知支持和工作障碍的评分，按照残疾程度进行分类。为这项研究开发的治疗算法被放置在那些被认为具有中度或高度残疾的患者的图表中。医生完成了研究前和研究后的记录。慢性疼痛患者可以成功地分类，根据残疾从他们的疼痛和医生是开放的接受治疗指南。到研究结束时，初级保健医生报告说，他们对治疗慢性疼痛的信心有所提高。大多数人认为慢性疼痛管理是他们实践中的一个问题，他们认识到治疗算法的好处。然而，许多医生表示不愿意在治疗慢性疼痛时定期咨询算法。识别障碍的实施DM疼痛计划，并讨论了未来的实施建议。
Objective. This study investigated the implementation of a disease management (DM) program for chronic pain among primary care physicians. Its aim was the dissemination of guidelines for the treatment of chronic pain to help primary care physicians identify, treat, and manage patients highly impaired by pain. The goals of the program were: 1) To identify those pain patients who are at greatest disability due to pain; 2) To assess the impact of a DM program for pain on clinical practice; and 3) To evaluate the effect of the program on physician's use, compliance, and satisfaction with guidelines.Methods. Thirty primary care physicians followed 82 patients who were identified as having chronic migraine headaches, back pain, or painful peripheral neuropathy. All patients were categorized according to their level of disability based on ratings of pain intensity, activity interference, emotional distress, perceived support, and work disability. Treatment algorithms developed for this study were placed in the charts of those patients considered to have moderate or high disability. Physicians completed pre- and poststudy questionnaires.Results. Chronic pain patients could be successfully classified according to the disability from their pain and physicians were open to accepting guidelines for treatment. By the end of the study, primary care physicians reported improved confidence in treating chronic pain. Most felt that chronic pain management was a problem in their practice, and they recognized the benefit of treatment algorithms. Many of the physicians, however, expressed reluctance to regularly consult the algorithms when treating chronic pain.Discussion. The identification of barriers for implementation of DM programs for pain is presented, and recommendations for future implementation are discussed.