证据与实践之间的永久鸿沟:分三步走解决基层医疗中慢性疼痛管理的持续障碍。

IF 2.5 Q2 CLINICAL NEUROLOGY
Frontiers in pain research (Lausanne, Switzerland) Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI:10.3389/fpain.2024.1376462
Laura Ellen Ashcraft, Megan E Hamm, Serwaa S Omowale, Valerie Hruschak, Elizabeth Miller, Shaun M Eack, Jessica S Merlin
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引用次数: 0

摘要

背景:慢性疼痛是一种影响数百万人身心健康的严重疾病,大多数慢性疼痛的治疗都是在初级保健机构进行的。初级保健医生(PCPs)试图提供以证据为基础的慢性疼痛治疗方法。然而,人们所接受的治疗与证据之间仍然存在差距。本研究的目标是:(1) 探讨循证慢性疼痛管理的决定因素;(2) 开发一种新方法,利用实施科学来解决证据与实践之间的差距:对宾夕法尼亚州 21 名初级保健医生进行了一次性半结构化电话访谈。访谈内容被逐字记录,分析过程中使用了演绎法和归纳法。我们使用了实施研究综合框架 (CFIR) 和实施变革专家建议 (ERIC) 来指导我们的分析和研究结果:结果:我们确定了基于证据的慢性疼痛管理在干预特征、个人特征和外部环境等 CFIR 领域的决定因素,并报告了实施策略。根据确定的主题,我们制定了一个三步流程,以支持在初级医疗机构中持续、务实地实施循证慢性疼痛管理:结论:在将实施科学纳入慢性疼痛管理方面,我们已经做出了努力,但差距依然存在。实施方法应优先考虑慢性疼痛患者及其家人的需求。此外,未来使用的方法或策略应以当前的三步模式为基础,包括第四步,即根据临床环境中慢性疼痛的具体需求调整现有的实施策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The perpetual evidence-practice gap: addressing ongoing barriers to chronic pain management in primary care in three steps.

Background: Most management of chronic pain, a serious illness affecting the physical and psychological wellbeing of millions, occurs in primary care settings. Primary care practitioners (PCPs) attempt to provide evidence-based practices to treat chronic pain. However, there continues to be a gap between the care people receive and the evidence. The objectives for this study were to (1) explore determinants of evidence-based chronic pain management and (2) develop a novel approach to using implementation science to address the evidence-practice gap.

Method: A convenience sample of twenty-one Pennsylvania PCPs participated in one-time semi-structured telephone interviews. Interviews were transcribed verbatim and both deductive and inductive approaches were used during analysis. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to inform our analysis and findings.

Results: We identified determinants of evidence-based chronic pain management across the CFIR domains of Intervention Characteristics, Characteristics of Individuals, and the Outer Setting and reported implementation strategies. Based on identified themes, we developed a three-step process to support the ongoing and pragmatic implementation of evidence-based chronic pain management in primary care settings.

Conclusions: Previous efforts exist to integrate implementation science into chronic pain management; yet a gap persists. Implementation approaches should prioritize the needs of people living with chronic pain and their families. Further, future approaches or strategies used should build on the current three-step model to include the fourth step of tailoring existing implementation strategies to the specific needs of chronic pain in the clinical context.

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CiteScore
2.10
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