Enhanced discharge counseling to reduce outpatient opioid use after cesarean delivery: a randomized clinical trial.
Enhanced discharge counseling to reduce outpatient opioid use after cesarean delivery: a randomized clinical trial.
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DOI：
10.1016/j.ajogmf.2020.100286
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发表时间：
2021-01
影响因子：
6.3
通讯作者：
Osmundson SS
中科院分区：
文献类型：
--
作者：
Lam L;Richardson MG;Zhao Z;Thampy M;Ha L;Osmundson SS
遏制过度处方的策略主要侧重于将处方者作为干预点。关于如何让患者减少使用阿片类药物并减少剩余阿片类药物的数量，人们知之甚少。先前针对非产科人群的研究表明，向患者提供关于适当使用阿片类药物的咨询可以改善未使用的阿片类药物的处置以及有关阿片类药物使用的整体知识。关于咨询是否会减少出院后阿片类药物的使用，人们知之甚少。本研究探讨加强剖腹产后最佳镇痛使用的出院咨询是否会减少阿片类药物的使用，并提高出院后未使用的阿片类药物的正确处置和阿片类药物的使用知识。接受简单剖腹产的妇女被随机分配接受有关最佳镇痛使用或常规护理的强化咨询。加强辅导主要针对以下四点：（1）剖腹产后疼痛属正常现象； (2) 应定期服用布洛芬以维持基线疼痛控制； (3)阿片类药物应谨慎使用，并应在几天内逐渐减量； (4) 所有未使用的阿片类药物应返回药房或冲入厕所。所有参与者在出院时均服用 30 片 5 毫克氢可酮-乙酰氨基酚和 30 片 600 毫克布洛芬。 14 天后联系她们，以确定阿片类药物的使用情况和剩余阿片类药物的位置，并完成 10 个问题的镇痛策略测验，得分为 1 到 10。我们估计，通过加强咨询，总共 172 名女性的结果数据将提供 80% 的功效来检测出院后阿片类药物使用量减少 30%。值得注意的是，79% 的符合条件的女性同意这项研究，196 名参与者中的 175 名（84 名强化咨询，91 名常规护理）完成了随访。与常规护理相比，强化咨询组更有可能遵循正确处置阿片类药物的建议（风险比，2.3；95% 置信区间，1.3-3.9）。他们在镇痛策略测验中的得分也显着高于常规护理组（10 分 [四分位距，9-10] 与 8 分[四分位距，7-9]；P<.001）。尽管与常规护理组相比，强化咨询组使用的阿片类药物较少（7.5 片[四分位距，2-15] vs 10.0 片[四分位距，2-16]；P=.55），处方阿片类药物比例也较小（25.0% [6.7-50.0] vs 33.3% [6.7-53.3]，P=.55），但差异不具有统计学意义。没有统计学上显着的证据表明参与者的教育水平与任何研究结果之间存在相互作用。加强出院阿片类药物咨询使参与者报告正确阿片类药物处置的频率增加了一倍，并提高了对阿片类药物相关风险的整体了解。这种干预措施并没有减少阿片类药物总体使用率较低的女性群体中阿片类药物的使用。这些发现强调了干预过度处方的短期（滥用和转移）和长期（持续使用阿片类药物）后果的可能方法。
Strategies to curb overprescribing have focused primarily on the prescriber as the point of intervention. Less is known about how to empower patients to use fewer opioids and decrease the quantity of leftover opioids. Previous studies in nonobstetrical populations suggest that patient counseling about appropriate opioid use improves disposal of unused opioids and overall knowledge about opioid use. Less is known about whether counseling reduces opioid use after hospital discharge. This study examines whether enhanced discharge counseling on optimal analgesic use after cesarean delivery reduces opioid use and improves proper disposal of unused opioids and opioid use knowledge after hospital discharge. Women who underwent an uncomplicated cesarean delivery were randomized to enhanced counseling on optimal analgesic use or usual care. Enhanced counseling addressed the following 4 points: (1) pain is normal after cesarean delivery; (2) scheduled ibuprofen should be taken to maintain baseline pain control; (3) opioids should be used sparingly and should be tapered over several days; and (4) all unused opioids should be returned to pharmacy or flushed in a toilet. All participants received 30 tablets of 5 mg hydrocodone-acetaminophen and 30 tablets of 600 mg ibuprofen at discharge. They were contacted 14 days later to determine opioid use and location of leftover opioids and to complete a 10-question analgesic strategies quiz with a score of 1 to 10. We estimated that outcome data on 172 women total would provide an 80% power to detect a 30% reduction in postdischarge opioid use with enhanced counseling. Notably, 79% of eligible women consented to the study and 175 of 196 participants (84 enhanced counseling, 91 usual care) completed the follow-up. Compared with usual care, the enhanced counseling group was more likely to follow recommendations for proper opioid disposal (risk ratio, 2.3; 95% confidence interval, 1.3–3.9). They also scored significantly higher on the analgesic strategies quiz (10 points [interquartile range, 9–10] vs 8 points [interquartile range, 7–9]; P<.001) than the usual care group. Although the enhanced counseling group used less opioids (7.5 tablets [interquartile range, 2–15] vs 10.0 tablets [interquartile range, 2–16]; P=.55) and a smaller proportion of prescribed opioids (25.0% [6.7–50.0] vs 33.3% [6.7–53.3], P=.55) than the usual care group, differences were not statistically significant. There was no statistically significant evidence of interaction between participant education level and any of the study outcomes. Enhanced discharge opioid counseling doubled the frequency of participants reporting proper opioid disposal and improved overall knowledge about the risks associated with opioids. This intervention did not decrease opioid use in a population of women with low overall opioid use. These findings highlight possible methods to intervene on the short-term (misuse and diversion) and long-term (persistent opioid use) consequences of overprescribing.
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影响因子：
1.9
作者：
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通讯作者：
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Scarpato, Kristen R.