电子健康记录干预措施减少术后的普雷加巴林处方:质量改进倡议
Sarah Tierney1,2, Ahmed Abbas3,4, Kiran Mysore3,4
1Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. sartierney@toh.ca.
Canadian journal of anaesthesia = Journal canadien d'anesthesie
|September 30, 2025
概括
电子健康记录干预并没有显著改变急性疼痛服务的普雷加巴林处方. 然而,降低普雷加巴林的使用并没有导致患者疼痛得分增加.
科学领域:
- 药理学和临床药学 药理学和临床药学
- 医疗信息学 医疗信息学
- 质量改善倡议 质量改善倡议
背景情况:
- 术后的 gabapentinoids,像pregabalin,可能提供有限的疼痛缓解,并携带不良事件的风险.
- 通过电子健康记录 (EHR) 干预来优化药物处方对于患者安全和有效的疼痛管理至关重要.
- 急性疼痛服务 (APS) 在治疗术后疼痛和药物使用方面发挥着关键作用.
研究的目的:
- 评估两个EHR干预措施对学术健康科学网络APS中的普拉加巴林处方模式的影响.
- 评估前加巴林处方的变化是否与术后疼痛强度的变化有关.
主要方法:
- 采用了准实验性中断时间序列设计,分析了基线和两次干预后期间的10,667名患者的数据.
- 干预措施包括对普雷加巴林风险的最佳实践咨询警告,以及从标准APS订单检查框中删除普雷加巴林.
- 分段回归分析量化了普雷加巴林处方比例和术后疼痛得分的变化.
主要成果:
- 预加巴林的处方从预干预的23.1%下降到第一个EHR干预后的16.7%,第二次干预后的17.3%.
- 间断时间序列分析显示,与EHR干预相关的处方没有显著的即时,趋势或总的反事实差异.
- 尽管pregabalin使用的趋势下降,但术后疼痛强度得分保持不变.
结论:
- 实施的EHR干预措施没有显示出与APS降低了普雷加巴林处方的显著关联.
- 观察到pregabalin利用率持续下降,而急性术后疼痛没有相应增加.
- 可能需要进一步的研究来探索优化加巴类药物在术后疼痛管理中的使用的替代策略.
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