Chronic noncancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse
Chronic noncancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse
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DOI：
10.1080/00325481.2015.993572
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发表时间：
2015-01-01
影响因子：
4.2
通讯作者：
Oner, Mehmet
中科院分区：
文献类型：
--
作者：
Kavukcu, Ethem;Akdeniz, Melahat;Oner, Mehmet
目的：大多数慢性非癌性疼痛（CNCP）患者在初级保健机构进行管理。初级保健家庭医生（PCFP）通常只有有限的时间，培训或资源来有效地评估和治疗这些患者，特别是当处方阿片类药物的潜在责任增加时。本研究的目的是通过阿片类药物滥用风险评估教育，使CNCP中PCFP对阿片类药物使用的知识，态度和行为发生有利的变化。材料与方法：这项横断面研究的对象包括36名在安塔利亚省卫生局下属家庭健康中心工作的家庭医生，他们自愿参加这项研究。最初，在干预组和对照组中进行了患者风险评估调查;而干预组接受了阿片类药物滥用风险评估的教育，对照组没有。6个月后重复调查，干预组接受核心检查。使用社会科学18.0统计程序的统计软件包对获得的数据进行分析。比较干预组和对照组。并对干预组教育前后的效果进行比较。结果如下：约61.1%的家庭医生报告了由于已知风险（如过量、成瘾、依赖或转移）而对阿片类药物处方的担忧和犹豫，并同意家庭医生在CNCP中使用阿片类药物前应进行风险评估。只有16.6%的PCFP报告说，风险评估是没有必要的，而22.2%的PCFP未定。虽然47.2%的家庭医生表示愿意在开始使用阿片类药物前进行风险评估，但在教育后，渴望使用阿片类药物的比例明显上升至77.7%，但执业比例的增加没有统计学意义。结论：家庭医生对CNCP的管理知识和能力得到了提高。虽然对阿片类药物滥用风险评估的渴望率有所增加，但使用风险评估率的预期增加并未实现。需要进一步的研究，以确定在改变的态度和实践的初级保健医生对这个问题的困难的原因。
Objective: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs' knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. Materials and methods: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. Results: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. Conclusion: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.