患者与麻醉团队之间的种族和民族一致性以及患者对剖腹产期间疼痛管理的满意度。

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Anesthesia and analgesia Pub Date : 2024-11-01 Epub Date: 2024-05-20 DOI:10.1213/ANE.0000000000006764
Jose Sanchez, Rohan Prabhu, Jean Guglielminotti, Ruth Landau
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引用次数: 0

摘要

背景:患者与医疗服务提供者之间的种族和民族一致性可提高患者的满意度,但在产科麻醉护理方面尚未进行过研究。本研究评估了种族和民族一致性与剖宫产疼痛管理(PDCD)满意度之间的关系:这是对在神经麻醉下进行剖宫产的一组患者进行的二次分析,对 PDCD 进行了检查。结果是满意度,在产后 48 小时内使用调查问题记录:"总体而言,您对剖腹产期间与疼痛管理相关的麻醉护理的满意度如何?满意度采用 5 点李克特量表,答案为 "非常满意"。参与者还被问到:"如果您再次进行剖腹产,您是否会想要同一个麻醉团队?患者与麻醉团队成员(主治医师与住院医师、麻醉师或研究员)之间的种族和民族一致性被暴露出来,分为完全一致、部分一致、不一致和缺失。通过多变量分析确定了满意度的风险因素:在 403 名参与者中,有 305 人(78.2%;95% 置信区间 [CI],73.8-82.1)"非常满意",399 人中有 358 人(89.7%;95% 置信区间 [CI],86.3-92.5)"想要同一个麻醉团队"。完全一致的有 18 例(4.5%),部分一致的有 117 例(29.0%),不一致的有 175 例(43.4%),缺失的有 93 例(23.1%)。完全一致的满意率为 88.9%,部分一致的满意率为 71.8%,不一致的满意率为 81.1%,缺失的满意率为 78.5%(P 值 = .202)。在多变量分析中,没有足够的证据表明一致性与满意度有关。与完全一致相比,部分一致与 "满意 "几率下降 57% (95% CI,-113-91)、不一致与 "满意 "几率下降 29% (95% CI,-251-85)和缺失与 "满意 "几率下降 39% (95% CI,-210-88)无显著关系。不 "非常满意 "的风险因素包括PDCD、焦虑症、体外受精导致的妊娠、静脉用药、产中剖宫产并延长产程硬膜外麻醉、有3名麻醉团队成员(而不是2名)以及术中失血较多:我们无法确定一致性与满意度之间的关系,这可能是因为我们队列中的满意度较高(78.2%),而完全一致的比例较低(4.5%)。我们需要解决诸如PDCD、焦虑、静脉用药、剖宫产硬膜外麻醉的使用等因素,并更好地理解一致性和满意度之间的相互作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Racial and Ethnic Concordance Between the Patient and Anesthesia Team and Patients' Satisfaction With Pain Management During Cesarean Delivery.

Background: Racial and ethnic concordance between patients and health care providers increases patient satisfaction but has not been examined in obstetric anesthesia care. This study evaluated the association between racial and ethnic concordance and satisfaction with management of pain during cesarean delivery (PDCD).

Methods: This was a secondary analysis on a cohort of patients undergoing cesarean deliveries under neuraxial anesthesia that examined PDCD. The outcome was satisfaction, recorded within 48 hours after delivery using the survey question, "Overall, how satisfied are you with the anesthesia care during the C-section as it relates to pain management?" Using a 5-point Likert scale, satisfaction was defined with the answer "very satisfied." Participants were also asked, "If you have another C-section, would you want the same anesthesia team?" The exposure was racial and ethnic concordance between the patient and anesthesia team members (attending with a resident, nurse anesthetist, or fellow) categorized into full concordance, partial concordance, discordance, and missing. Risk factors for satisfaction were identified using a multivariable analysis.

Results: Among 403 participants, 305 (78.2%; 95% confidence interval [CI], 73.8-82.1) were "very satisfied," and 358 of 399 (89.7%; 95% CI, 86.3-92.5) "would want the same anesthesia team." Full concordance occurred in 18 (4.5%) cases, partial concordance in 117 (29.0%), discordance in 175 (43.4%), and missing in 93 (23.1%). Satisfaction rate was 88.9% for full concordance, 71.8% for partial concordance, 81.1% for discordance, and 78.5% for missing ( P value = .202). In the multivariable analysis, there was insufficient evidence for an association of concordance with satisfaction. Compared to full concordance, partial concordance was associated with a nonsignificant 57% (95% CI, -113 to 91) decrease in the odds of being satisfied, discordance with a 29% (95% CI, -251 to 85) decrease, and missing with a 39% (95% CI, -210 to 88) decrease. Risk factors for not being "very satisfied" were PDCD, anxiety disorders, pregnancy resulting from in vitro fertilization, intravenous medication administration, intrapartum cesarean with extension of labor epidural, having 3 anesthesia team members (instead of 2), and a higher intraoperative blood loss.

Conclusions: Our inability to identify an association between concordance and satisfaction is likely due to the high satisfaction rate in our cohort (78.2%), combined with low proportion of full concordance (4.5%). Addressing elements such as PDCD, anxiety, intravenous medication administration, and use of epidural anesthesia for cesarean delivery, and a better understanding of the interplay between concordance and satisfaction are warranted.

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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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