学术详细化以改善适当的阿片类药物处方:一种混合方法的评估过程
Natasha Kithulegoda1, Cherry Chu2, Mina Tadrous2
1Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont. natasha.kithulegoda@wchospital.ca.
学术详细说明通过解决疼痛管理障碍和增强处方知识,在家庭医生中显著减少了阿片类药物处方. 这种教育宣传改善了临床实践和患者护理.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医学教育 医学教育
- 疼痛管理 疼痛管理
背景情况:
- 学术详细,一个教育外展服务,在安大略省实施,以改善家庭医生之间的阿片类药物处方和疼痛管理.
- 该研究旨在评估该服务对阿片类药物处方实践的影响.
研究的目的:
- 评估学术细节在修改阿片类药物处方模式方面的有效性.
- 探索学术细节影响医生的处方行为和疼痛管理策略的机制.
主要方法:
- 采用混合方法方法,从2017年到2019年收集定量处方数据和定性访谈数据.
- 在接受学术详细信息的医生和匹配的对照组之间比较了处方结果.
- 以理论领域框架为指导的定性访谈探索了医生的经验和对学术细节的看法.
主要成果:
- 与对照组相比,参与学术细节的医生在阿片类药物处方方面表现出更大的减少 (n=238 vs. n=238).
- 与17名医生的采访显示,学术细节解决了诸如缺乏信心,患者互动挑战和处方/缩减决策等障碍.
- 实践变革的关键驱动因素包括加强知识,讨论复杂的患者病例,以及难以进行对话的策略.
结论:
- 学术详细有效地解决了障碍和推动者,以减少高风险的阿片类药物处方在初级保健.
- 这项研究提供了对教育外展如何改善阿片类药物管理的细微了解.
- 这些发现将为学术详细服务的更广泛实施和扩展提供信息.
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