潜在的,全系统干预对影响阿片类药物处方实践在背痛患者中的影响
Virgenal Owens1, Meghan K Wally1, Ziqing Yu1
1Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.
The Journal of emergency medicine
|February 7, 2025
概括
对阿片类药物滥用风险的临床决策支持工具对急诊室背部疼痛处方的影响很小. 该干预只影响了6.6%的阿片类药物处方,突出显示了改变处方习惯的挑战.
科学领域:
- 紧急医疗 紧急医疗
- 临床信息学 临床信息学
- 公共卫生 公共卫生
背景情况:
- 阿片类药物流行需要干预,以制滥用.
- 一个基于警报的临床决策支持 (CDS) 系统被开发来识别患有阿片类药物滥用风险的患者.
- 该系统使用了五个基于证据的风险因素:早期补充,频繁的ED/紧急护理访问,多次处方,先前的过量服用和阳性毒理学查.
研究的目的:
- 评估CDS干预对脊椎疼痛患者阿片类药物处方的影响.
- 测量因响应警报而修改的阿片类药物处方的百分比.
主要方法:
- 对93,192名在急诊室出现背痛的成年患者进行前性观察性研究 (2017-2021年).
- 在PRIMUM干预后",决定受影响" (处方修改/取消) 的计算率.
- 描述患者,遭遇和处方数据.
主要成果:
- 30.2%的背痛患者接受了阿片类药物处方.
- 在那些被处方的阿片类药物中,18.6%的人至少有一种危险因素.
- 在19.8%的遭遇中引发了警报;正确的毒理学是最常见的危险因素 (52.1%).
- 处方决定在6.6%的警报遭遇中受到影响,最高的是"三次或更多处方" (11.8%) 和"早期补充" (9.1%).
结论:
- 大约三分之一的急诊室患者背部疼痛接受阿片类药物处方.
- CDS干预对这种患者群体的阿片类药物处方决定的影响很小.
- 慢性疼痛患者更有可能接受阿片类药物,这表明需要有针对性的策略.
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