慢性疼痛患者的困难遭遇:一项队列研究。

IF 6.9 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Mayo Clinic proceedings Pub Date : 2025-01-01 Epub Date: 2024-12-05 DOI:10.1016/j.mayocp.2024.08.010
Steven P Cohen, Winnie L Liu, Tina L Doshi, Eric J Wang, Evelien van Gelderen, Resham Mawalkar, Eellan Sivanesan, Kayode A Williams, Paul J Christo, Shravani Durbhakula, Glenn Treisman, Annie Hsu
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引用次数: 0

摘要

目的:确定与临床困难接触相关的变量。患者和方法:这是一项横断面研究,在2022年至2023年期间评估了428名新患者。记录了人口统计、临床、社会(例如,错过预约、先前的重罪定罪、以前的疼痛医生、医疗援助)和访问相关(例如,访问时间比预期长、沟通困难)的信息,并辅以受训人员和主治人员收集的亲自历史,他们的人口统计数据也被记录下来。医生们按照李克特量表(Likert scale)的6分制,对这次会面的“难度”进行独立评级,1 =非常容易/愉快,2 =容易/愉快,3 =一般/一般,4 =困难,5 =非常困难,6 =极其困难。一个困难的遭遇是实习生和主治医师的综合评分高于中位数2.0±1.75。结果:428名参与者平均±SD年龄为54.2±15.8岁,女性261人(61.0%)。就诊性别、性别一致性、种族一致性和医师经验年数与困难无关。在多变量分析中,要求阿片类药物(P=.001)、比预期就诊时间更长(P结论:大多数与医生对困难就诊印象相关的变量都与就诊有关,这表明一些与患者相关的因素(如既往药物滥用、翻译要求)可能与疼痛患者的相关性较低。未来的研究应评估旨在减少遭遇困难的干预措施,并确定其对患者和医生的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Difficult Encounters in Chronic Pain Patients: A Cohort Study.

Objective: To determine variables associated with difficult clinical encounters.

Patients and methods: This was a cross-sectional study of 428 new patients evaluated from 2022 to 2023. Demographic, clinical, social (eg, missed appointments, prior felony conviction, prior pain physicians, medical assistance) and visit-related (eg, visit took longer than expected, difficulty communicating) information was recorded, supplemented by in-person history gathered by the trainee and attending whose demographic data were also recorded. Physicians independently rated the "difficulty" of the encounter on a 6-point Likert scale from 1 = very easy/pleasant, 2 = easy/pleasant, 3 = neutral/average, 4 = difficult, 5 = very difficult, to 6 = extremely difficult. A difficult encounter was a combined trainee and attending rating of one IQR above the median of 2.0±1.75.

Results: Among 428 participants, mean ± SD age was 54.2±15.8 years and 261 (61.0%) were female. Attending gender, gender concordance, race and racial concordance, and years of physician experience were not associated with difficulty. In multivariable analysis, requesting opioids (P=.001), lengthier than expected visit (P<.001), hostile/demanding behavior (P=.003), refusal to try recommended treatment (P=.002), unrealistic expectations (P<0.001), and difficulty communicating (P=.02) were associated with difficult encounters.

Conclusion: Most variables associated with physician impressions of difficult encounters were visit-related, suggesting some patient-related factors (eg, prior substance abuse, translator requirement) may be less relevant in pain patients. Future research should evaluate interventions designed to decrease the difficulty of encounters and determine their effect on patients and physicians.

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来源期刊
Mayo Clinic proceedings
Mayo Clinic proceedings 医学-医学:内科
CiteScore
16.80
自引率
1.10%
发文量
383
审稿时长
37 days
期刊介绍: Mayo Clinic Proceedings is a premier peer-reviewed clinical journal in general medicine. Sponsored by Mayo Clinic, it is one of the most widely read and highly cited scientific publications for physicians. Since 1926, Mayo Clinic Proceedings has continuously published articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal welcomes submissions from authors worldwide and includes Nobel-prize-winning research in its content. With an Impact Factor of 8.9, Mayo Clinic Proceedings is ranked #20 out of 167 journals in the Medicine, General and Internal category, placing it in the top 12% of these journals. It invites manuscripts on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics.
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