Clinician perspectives on the postpartum pain experience and attitudes about pain management

项目摘要 阿片类药物滥用在美国已被宣布为国家紧急状态。超过一半的住院病人 患者在住院期间接受阿片类药物。由于分娩是住院的最常见原因， 生育年龄的人特别容易受到阿片类药物暴露的影响，是一个重要的人群， 解决阿片类药物流行问题。事实上，我们的数据表明， 和门诊阿片类药物的使用，产后疼痛管理的广泛变化，阿片类药物缺乏一致性， 根据患者疼痛报告开具处方，以及产科临床医生对阿片类药物处方的贡献。 阿片类药物流行病对种族/民族的影响不同;少数种族/民族的个体不太可能 接受阿片类药物进行疼痛管理的比例高于非西班牙裔白色个体。值得注意的是，我们的数据显示， 尽管报告产后疼痛水平较高，但少数种族/民族分娩个体接受的阿片类药物较少 在住院期间接受治疗，出院时较少开具阿片类药物处方。一个完整 理解并最终改善这些经验和减少差距，需要更深入的 深入研究影响，指导临床医生在他们的管理产后疼痛。 该提案旨在满足系统、深入和无偏见地评价产科疾病的需求， 临床医生对产后疼痛管理的经验。我们提出了一个前瞻性的定性研究， 产科临床医生，检查影响他们产后疼痛管理方法的因素，偏见 这可能导致差异，以及他们对减少阿片类药物干预措施的看法和偏好 改善疼痛控制。我们将进行深入的重点小组多达50名产科医生，包括 医生、高级执业医师和护士。目标1将评估信念和影响因素 临床医生对产后疼痛的管理，包括可能导致 差距。使用实施科学的综合框架，目标2将评估临床医生的 减少产后阿片类药物处方和改善 疼痛控制，以优化未来干预措施的实施。 优化产后健康，减少阿片类药物过度使用，减少护理和结果的差异至关重要 主要专业协会的目标和NICHD 2020战略计划。结合以患者为中心 研究产后疼痛管理（3R 01 HD 098178 - 02 S1），这项工作的目的是创造一个必要的 制定和实施有效和公平的干预措施， 阿片类药物处方和疼痛管理。

PROJECT SUMMARY Opioid misuse has been declared a national emergency in the United States. More than half of hospitalized patients receive an opioid during their hospitalization. As birth is the most common reason for hospitalization, reproductive-aged individuals are particularly vulnerable to opioid exposure and are an important population for addressing the opioid epidemic. Indeed, our data have demonstrated the high frequency of postpartum inpatient and outpatient opioid use, the wide variation in postpartum pain management, the lack of alignment of opioid prescribing with patient reports of pain, and the contributions of obstetric clinicians to opioid prescribing. The opioid epidemic has a differential impact by race/ethnicity; individuals of minority race/ethnicity are less likely to receive an opioid for pain management than non-Hispanic White individuals. Notably, our data show that, despite reporting higher levels of pain postpartum, minority race/ethnicity birthing individuals receive less opioid treatment as inpatients and are less frequently prescribed an opioid upon hospital discharge. A complete understanding and, ultimately improvement, of these experiences and reduction in disparities requires a deeper delve into influences which guide clinicians in their management of postpartum pain. This proposal aims to fill an unmet need for a systematic, in-depth, and unbiased evaluation of obstetric clinicians’ experience of postpartum pain management. We propose a prospective qualitative study of obstetric clinicians, examining factors which influence their approach to postpartum pain management, biases which may contribute to disparities, and their perspectives and preferences of interventions to reduce opioids and improve pain control. We will conduct in-depth focus groups of up to 50 obstetric clinicians, including physicians, advanced practitioners, and nurses. Aim 1 will evaluate beliefs and factors which influence clinicians’ management of postpartum pain, including potential clinician-level biases which may contribute to disparities. Using the Consolidated Framework for Implementation Science, Aim 2 will evaluate clinicians’ perspectives and preferences of interventions to reducing postpartum opioid prescribing and improving pain control, in order to optimize the implementation of future interventions. Optimizing postpartum health, reducing opioid overuse, and reducing disparities in care and outcomes are critical goals of major professional societies and the NICHD 2020 strategic plan. In combination with patient-focused research on postpartum pain management (3R01HD098178-02S1), this work aims to create an essential foundation from which to develop and implement effective and equitable interventions to optimize postpartum opioid prescribing and pain management.