Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care.
Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care.
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DOI：
10.1186/s12913-023-09330-w
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发表时间：
2023-04-01
影响因子：
2.8
通讯作者：
Knight, Kelly Ray
中科院分区：
文献类型：
--
作者：
Cooke, Alexis;Castellanos, Stacy;Enriquez, Celeste;Olsen, Pamela;Miaskowski, Christine;Kushel, Margot;Knight, Kelly Ray
SARS-CoV-2 （COVID-19）大流行增加了远程医疗在初级保健安全网临床系统中用于管理阿片类药物使用障碍和慢性非癌性疼痛的使用。远程保健存在重大障碍，但人们对这些障碍如何影响城市安全网、初级保健提供者及其患者知之甚少。本研究的目的是定性评估远程医疗管理慢性非癌性疼痛、阿片类药物使用障碍和初级保健、安全网临床系统中的多发病的益处和挑战。我们于2020年3月至7月在旧金山湾区采访了患有慢性非癌症疼痛和药物使用史的患者（n = 22）及其初级保健临床医生（n = 7）。我们记录、转录、编码和分析采访内容。COVID-19临时安置令导致药物使用和无法控制的疼痛增加，并对通过远程医疗监测阿片类药物安全和滥用构成挑战。由于数字素养/访问能力低，没有一家诊所使用视频就诊。远程保健的好处包括减轻病人负担和减少错过预约，增加对一些慢性病（如糖尿病、高血压）的便利和控制。远程医疗面临的挑战包括失去联系、更多的沟通不畅和更少的全面护理互动。本研究是第一个检查远程医疗在城市安全网初级保健患者同时发生慢性非癌症疼痛和物质使用的研究之一。决定继续或扩大远程医疗应考虑患者负担、通信和技术挑战、疼痛控制、阿片类药物滥用和医疗复杂性。
The SARS-CoV-2 (COVID-19) pandemic increased use of telehealth for the management of opioid use disorder and chronic non-cancer pain in primary care safety net clinical systems. Significant barriers to telehealth exist, little is known about how these barriers impact urban safety net, primary care providers and their patients. The objective of this study was to qualitatively assess the benefits and challenges of telehealth for management of chronic non-cancer pain, opioid use disorder, and multi-morbidity in primary care, safety net clinical systems. We interviewed patients with chronic non-cancer pain and history of substance use (n = 22) and their primary care clinicians (n = 7) in the San Francisco Bay Area, March-July 2020. We recorded, transcribed, coded, and content analyzed interviews. COVID-19 shelter-in-place orders contributed to increases in substance use and uncontrolled pain, and posed challenges for monitoring opioid safety and misuse through telehealth. None of the clinics used video visits due to low digital literacy/access. Benefits of telehealth included decreased patient burden and missed appointments and increased convenience and control of some chronic conditions (e.g., diabetes, hypertension). Telehealth challenges included loss of contact, greater miscommunication, and less comprehensive care interactions. This study is one of the first to examine telehealth use in urban safety net primary care patients with co-occurring chronic non-cancer pain and substance use. Decisions to continue or expand telehealth should consider patient burden, communication and technology challenges, pain control, opioid misuse, and medical complexity.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
通过远程医疗对阿片类药物使用障碍治疗的药物满意：简要文献综述和开发了新评估。
影响因子：
5.2
作者：
Cole TO;Robinson D;Kelley-Freeman A;Gandhi D;Greenblatt AD;Weintraub E;Belcher AM
通讯作者：
Belcher AM
影响因子：
8
作者：
Katzow, Michelle W.;Steinway, Caren;Jan, Sophia
通讯作者：
Jan, Sophia
影响因子：
4.2
作者：
John, William S.;Wu, Li-Tzy
通讯作者：
Wu, Li-Tzy
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R