在慢性非癌症疼痛中探索阿片类药物管理挑战:来自德国全科医生中混合方法研究的发现
Sabrina Brinkmöller1, Regina Poß-Doering1, Alexandra Balzer2
1Department of Primary Care and Health Services Research, Heidelberg University, Medical Faculty/Heidelberg University Hospital, Heidelberg, Germany.
德国的全科医生在应用慢性疼痛阿片类药物指南方面存在差距. 障碍包括缺乏意识,患者的恐惧,以及偏爱个人经验而不是基于证据的建议.
科学领域:
- 疼痛管理 疼痛管理
- 一般实践一般实践
- 基于证据的医学基于证据的医学.
背景情况:
- 在德国,针对慢性非癌症疼痛的高强度阿片类药物处方正在增加.
- 一般医生 (GPs) 是主要的处方者,但指导方针的采用不清楚.
研究的目的:
- 调查医生对阿片类药物管理LONTS指南的应用.
- 确定在初级保健中实施这些建议的障碍.
主要方法:
- 混合方法研究,结合在线问卷和半结构面试.
- 调查问卷评估了与LONTS建议的偏差.
- 采访探讨了遵守指南的障碍.
主要成果:
- 45%的全科医生不知道LONTS指南.
- 关键差距包括:不经常设定目标 (40%),首选的组合疗法 (49%),使用短期阿片类药物单疗法 (17%),以及缺乏讨论阿片类药物减少 (44%).
- 发现的障碍:不良融入日常生活,患者害怕复发,依赖个人经验.
结论:
- 德国的全科医生面临着实施LONTS慢性非癌症疼痛指南的挑战.
- 有针对性的战略是必要的,以改善在初级保健中采用指南的情况.
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