对急性腰部疼痛患者初始初级护理订单的集群分析
Christopher T Joyce1, Eric J Roseen2, Clair N Smith2
1From the School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, MA (CTJ); Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA (EJR, EH, NEM); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CNS, CGP, CMM, JMS, AD); Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States (JB); Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, United States (JB); Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA (RBS). Christopher.Joyce@mcphs.edu.
初级保健医生 (PCP) 经常结合针对急性腰痛 (aLBP) 的指导方针一致和不一致的订单. 患有较高残疾和痛苦的患者更有可能接受与指南不一致的护理.
科学领域:
- 初级医疗保健医学 一级医疗保健医学
- 医疗保健服务研究 医疗服务研究
- 疼痛管理 疼痛管理
背景情况:
- 初级保健医生 (PCP) 在推急性腰部疼痛 (aLBP) 治疗方法时,需要考虑复杂的因素.
- 了解当前的处方模式对于改善LBP护理至关重要.
- 基于证据的指导方针存在,但并不总是遵循.
研究的目的:
- 为了确定患有aLBP的患者PCP订单的常见模式.
- 描述与这些护理模式相关的患者特征.
- 分析PCP订单与临床指南的一致性.
主要方法:
- 一项针对9574名aLBP患者的前性队列研究,涉及美国77家初级保健机构.
- 在初次访问后21天内对PCP订单进行集群分析,使用电子健康记录.
- 描述与订单模式相关的患者人口统计和临床因素.
主要成果:
- 确定了四种不同的订单模式:联合非药物/药物 (44%),二线药物 (39%),成像 (10%) 和专业转诊 (7%).
- 15%的患者没有具体的背痛顺序;这些患者的残疾程度较低.
- 患有较高残疾和心理困扰的患者更有可能接受与指南不一致的护理,经常结合推和非推的治疗方法.
结论:
- 对于aLBP,PCP经常将符合指导方针的订单和不符合指导方针的订单结合起来.
- 与指导方针不一致的护理与患者报告的残疾和心理困扰有关.
- 需要对患者,临床医生和设置因素进行进一步的研究,以指导对不协调的护理的实施努力.
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