大型手术后阿片类药物减少的处方默认推杆 (NORMS):一个随机对照试验
Irene Y Zhang1, David R Flum1, Saurabh Khandelwal1
1Department of Surgery, University of Washington School of Medicine, Seattle, WA.
Annals of surgery
|November 7, 2025
概括
电子健康记录的推动并没有减少手术后的整体阿片类药物处方. 然而,接受默认处方的外科医生显著减少了阿片类药物的使用,这表明可能需要更强有力的干预措施.
科学领域:
- 外科手术 医疗外科手术
- 医疗信息学 医疗信息学
- 疼痛管理 疼痛管理
背景情况:
- 解决国家阿片类药物危机需要优化术后阿片类药物处方.
- 电子健康记录 (EHR) 的行为推敲提供了一个潜在的解决方案,但需要在手术环境中进行测试.
研究的目的:
- 评估基于EHR的默认"推"干预对常见外科手术后阿片类药物处方的影响.
- 评估预先填充的阿片类药物处方在降低出院时吗啡毫克相当量 (MME) 的有效性.
主要方法:
- 一个随机临床试验,涉及一个学术医疗中心的118名外科临床医生.
- 临床医生被随机分配到使用电子出院顺序集的控制或干预组.
- 干预组提出了预先填充的阿片类药物和辅助处方;在出院时处方的MME是主要结果.
主要成果:
- 该研究分析了663次手术;中位数的阿片类药物处方是75MME.
- 治疗意向分析显示,小组之间的MME没有显著差异 (调整后的差异为2.4MME).
- 然而,接受预填充默认的外科医生 (21%的干预组) 处方的阿片类药物显著减少 (调整后的差异: -22.5 MME).
结论:
- 对于阿片类药物处方而言,默认的EHR推动并没有减少整体的术后阿片类药物使用.
- 一部分接受默认的外科医生表现出显著的阿片类药物减少.
- 为了有效优化阿片类药物处方,可能需要更强大的默认干预和共同干预.
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