在长期阿片类药物治疗的慢性疼痛患者的初级保健中进行患者激活干预:随机对照试验的结果
Monique B Does1, Sara R Adams2, Andrea H Kline-Simon2
1Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2403, USA. monique.does@kp.org.
BMC health services research
|January 23, 2024
概括
一个简短的初级保健干预改善了长期阿片类药物治疗患者的结果,包括减少抑郁症和改善整体健康. 虽然患者激活没有改善,但非药物治疗疼痛管理策略和卫生系统参与度增加.
科学领域:
- 疼痛管理 疼痛管理
- 初级保健干预措施 初级保健干预措施
- 患者激活的方法
背景情况:
- 长期使用处方阿片类药物存在重大风险,需要非药物治疗疼痛的替代方案.
- 患者激活干预可能会提高慢性疼痛患者的健康结果.
- 在ACTIVATE研究中,对长期服用阿片类药物治疗的初级保健患者进行了4次患者激活干预.
研究的目的:
- 在初级保健中评估患者激活干预措施的有效性.
- 评估干预对患者激活和相关结果的影响.
- 探索情绪,功能,整体健康和非药物疼痛管理策略的改善.
主要方法:
- 一个实用,随机的试验,涉及两个初级保健诊所.
- 参与者被随机分配到干预组 (n=189) 或通常护理组 (n=187).
- 通过在线和采访者管理的调查在基线,6个月和12个月评估结果,从EHR中提取了处方阿片类药物的使用情况.
主要成果:
- 在12个月后,患者激活 (PAM分数) 在组之间没有显著差异.
- 干预组显示中度/重度抑郁症减少 (OR=0.40) 和整体健康状况改善 (OR=3.14).
- 在干预组中观察到患者门户资源,冥想和运动/物理治疗的使用增加.
结论:
- 一个简短的初级保健干预可以改善长期阿片类药物治疗患者的各种患者报告的结果.
- 尽管没有改善患者激活,但干预措施增强了抑郁症,整体健康和非药物治疗的疼痛管理.
- 该干预措施还增加了患者与卫生系统的接触,特别是通过患者门户网站.
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