Quality Indicators for the Pharmacological Management of Chronic Non-Cancer Pain in Older Adult Patients: An Integrative Review

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-08-19 DOI:10.1111/jep.70253

Aljoscha Noël Goetschi, Henk Verloo, Nicole Schönenberger, Ursina Wernli, Carla Meyer-Massetti

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引用次数: 0

Abstract

Rationale

Chronic non-cancer pain (CNCP) affects 28%–88% of older adults. They also experience more medication-related problems and are more likely to receive insufficient pain therapy, impacting their quality of care. Quality indicators (QIs) can be used to assess and improve the quality of their care.

Aims and Objectives

This integrative review aimed to consolidate the scientific evidence on existing QIs for the pharmacological care of older adult patients with CNCP.

Methods

We systematically searched Medline and Embase via Ovid, CINAHL via EBSCO, the SCOPUS databases and Google Scholar. We used backward citation searching to identify additional studies. We included studies reporting validated QIs and studies reporting quality-related factors associated with reduced medication safety caused by pain-related medication therapy. Two reviewers independently screened the titles, abstracts and full texts. One extracted and charted the data and assessed the risk of bias; the second validated this.

Results

We screened 4068 articles identified through the systematic search of databases and 2774 articles identified via citation searching. Seventy-eight articles met our inclusion criteria and were retained for analysis. We extracted 11 validated QIs and developed a further 243 based on quality criteria reported in the literature. QIs covered different levels, from pharmacotherapy in general to particular substance groups and individual active substances. The risk of bias in the included studies was judged to be very high in the majority of studies.

Conclusion

This integrative review established a scientific basis for developing QIs for the pharmacological management of older adult patients with CNCP. The high risk of bias present in the included studies, highlights the need for expert validation and input from patients. These indicators could help improve the quality of care provided to older adult patients with CNCP and help focus specific interventions on vulnerable patients.

Abstract Image

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老年患者慢性非癌性疼痛药理管理的质量指标：一项综合评价

理由：慢性非癌性疼痛（CNCP）影响28%-88%的老年人。他们还会遇到更多与药物有关的问题，更有可能接受的疼痛治疗不足，从而影响他们的护理质量。质量指标（QIs）可用于评估和改善他们的护理质量。目的和目的本综述旨在巩固现有QIs对老年CNCP患者药理学护理的科学证据。方法通过Ovid系统检索Medline和Embase，通过EBSCO系统检索CINAHL，通过SCOPUS数据库和谷歌Scholar系统检索。我们使用反向引文检索来确定其他研究。我们纳入了报告有效质量指标的研究，以及报告与疼痛相关药物治疗导致的药物安全性降低相关的质量相关因素的研究。两位审稿人独立筛选标题、摘要和全文。一组提取数据并绘制图表，评估偏倚风险；第二次验证了这一点。结果通过数据库系统检索筛选出4068篇文献，通过引文检索筛选出2774篇文献。78篇文章符合我们的纳入标准，并被保留用于分析。我们提取了11个经过验证的QIs，并根据文献报道的质量标准开发了另外243个QIs。QIs涵盖了不同的水平，从一般药物治疗到特定物质组和个体活性物质。在纳入的研究中，大多数研究的偏倚风险被认为非常高。结论本综合评价为制定老年CNCP患者药理管理的QIs奠定了科学基础。纳入的研究中存在的高偏倚风险突出了对专家验证和患者输入的需求。这些指标可以帮助提高为老年CNCP患者提供的护理质量，并有助于将具体干预措施集中在弱势患者身上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.