解码大手术后阿片类药物停药策略中的行为改变技术:减少术后阿片类药物使用干预措施的系统综述。

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Neetu Bansal, Christopher J Armitage, Rhiannon E Hawkes, Sarah Tinsley, Darren M Ashcroft, Li-Chia Chen
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引用次数: 0

摘要

背景和目标方法:从开始到 2023 年 10 月,我们采用了结构化检索策略,包括 MEDLINE、Embase、CINAHL Plus、PsycINFO 和 Cochrane Library 等数据库。所纳入的研究侧重于针对成人重大手术后减少阿片类药物的干预措施。使用Cochrane偏倚风险工具V.2(RoB 2)和非随机干预研究(ROBINS-I)工具对偏倚风险进行了评估,并计算了Cohen's d效应大小。结果:共纳入 22 项研究,包括 7 项临床试验和 15 项队列研究,偏倚风险各不相同。教育性干预(12 项)、以指南为重点的干预(3 项)、多方面干预(5 项)和药剂师主导的干预(2 项)显示出不同的效应大小(中小型干预 10 项,大型干预 12 项)。各项研究共发现了 23 种独特的 BCT,共出现 140 次。在BCT的数量和效果大小之间没有发现明显的关联,效果大小较大的干预主要针对医护人员。效果最大的干预措施中的主要BCT包括行为指导、行为替代、目标设定(结果)、社会支持(实际)、社会支持(未指定)、药物支持、提示/线索、行为反馈、环境改变、分级任务、结果目标回顾、健康后果信息、行动规划、社会比较、可信来源、结果反馈和社会奖励:了解高效干预措施中占主导地位的 BCT 为今后实施阿片类药物减量策略提供了宝贵的见解。考虑到其他影响因素,有必要开展进一步的研究和验证,以确定BCT与有效性之间的关联:CRD42022290060。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Decoding behaviour change techniques in opioid deprescribing strategies following major surgery: a systematic review of interventions to reduce postoperative opioid use.

Background and objectives: METHODS: A structured search strategy encompassing databases including MEDLINE, Embase, CINAHL Plus, PsycINFO and Cochrane Library was implemented from inception to October 2023. Included studies focused on interventions targeting opioid reduction in adults following major surgeries. The risk of bias was evaluated using Cochrane risk-of-bias tool V.2 (RoB 2) and non-randomised studies of interventions (ROBINS-I) tools, and Cohen's d effect sizes were calculated. BCTs were identified using a validated taxonomy.

Results: 22 studies, comprising 7 clinical trials and 15 cohort studies, were included, with varying risks of bias. Educational (n=12), guideline-focused (n=3), multifaceted (n=5) and pharmacist-led (n=2) interventions demonstrated diverse effect sizes (small-medium n=10, large n=12). A total of 23 unique BCTs were identified across studies, occurring 140 times. No significant association was observed between the number of BCTs and effect size, and interventions with large effect sizes predominantly targeted healthcare professionals. Key BCTs in interventions with the largest effect sizes included behaviour instructions, behaviour substitution, goal setting (outcome), social support (practical), social support (unspecified), pharmacological support, prompts/cues, feedback on behaviour, environmental modification, graded tasks, outcome goal review, health consequences information, action planning, social comparison, credible source, outcome feedback and social reward.

Conclusions: Understanding the dominant BCTs in highly effective interventions provides valuable insights for future opioid tapering strategy implementations. Further research and validation are necessary to establish associations between BCTs and effectiveness, considering additional influencing factors.

Prospero registration number: CRD42022290060.

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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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