用于缓解疼痛和息治疗的基本药物的使用:全球共识进程
Tania Pastrana1, Liliana De Lima2, Deborah Dudgeon3
1Department of Palliative Medicine (T.P.), Medical Faculty RWTH Aachen University, Aachen, Germany; International Association for Hospice and Palliative Care (T.P., L.D.L., L.R.), Houston, USA.
Journal of pain and symptom management
|November 1, 2024
概括
息护理必需药物的证据和实践指南有限,特别是在最大每日剂量方面. 在全球范围内,可用性和培训方面的差异影响了症状管理.
科学领域:
- 抚慰性护理医学 抚慰性护理医学
- 药理学 药理学是指药理学的学科.
- 全球健康 全球健康
背景情况:
- 世界卫生组织 (WHO) 的基本药物模型清单包括24种疼痛和息护理药物.
- 柳叶刀基本包 (LEP) 包含35种治疗全球健康相关疾病的药物.
- 基本药物对于治疗疼痛和改善息治疗中的生活质量至关重要.
研究的目的:
- 建立基于证据的建议,以适当地使用在息治疗中的基本药物.
- 解决全球临床实践和缓和护理药物可用性的差距.
主要方法:
- 对19个选定的全球息护理指南进行系统审查.
- 提取世卫组织基本药物清单 (EML) 和LEP中药物的剂量数据.
- 70名国际专家参与的两轮德尔菲进程,以达成关于药物使用的共识,需要70%的同意.
主要成果:
- 对于24种药物的初始剂量和频率达成共识,但对于9种药物的最大每日剂量没有达成共识.
- 在高收入国家和低收入/中等收入国家之间观察到药物可用性的显著差异.
- 专家的共识强调了有限的证据和临床实践的广泛差异对于必要的息护理药物.
结论:
- 由于证据有限和实践差异,在制定建议方面取得了部分成功.
- 确定了影响息治疗的关键信息缺口,特别是在初级保健机构.
- 药物供应有限和培训不足阻碍了基于证据的症状管理,可能导致依赖试错方法.
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