脊柱手术后阿片类药物出院镇痛及护理的患者体验:一项混合方法研究。

IF 1.3 Q4 CLINICAL NEUROLOGY
Megan L Allen, Adam Pastor, Kate Leslie, Brennan Fitzpatrick, Malcolm Hogg, Hui Lau, Jo-Anne Manski-Nankervis
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引用次数: 0

摘要

背景:围手术期阿片类药物管理计划越来越多地被引入,以指导手术期间负责任的使用,以减少阿片类药物对患者的伤害。然而,围手术期阿片类药物管理项目的患者经验尚未得到充分探讨。方法:我们设计了一项混合方法研究,探讨脊柱手术后患者围手术期阿片类药物管理的经验。我们进行了评估性行动研究,结合了质量改进和人种学方法。我们的定量方法是回顾性病历回顾和针对性调查研究。我们的定性方法是在线焦点小组。定量资料采用描述性统计、卡方检验和秩和检验进行分析。对焦点小组数据进行归纳性专题分析。结果:我们的脊柱外科队列在四个月的研究期间包括101例患者。出院时分配的阿片类药物中位数为75 mg[四分位数范围为75-150 mg],其中30%的患者在出院时使用改良释放阿片类药物。一部分患者(N = 14)参加了在线焦点小组。从这些会议中出现的关键主题是:(1)支持性护理交付和救援机制对患者参与者普遍重要,在他们康复期间提供极大的保证;(2)参与者普遍认为阿片类镇痛在脊柱手术后恢复中起重要作用。一些患者热衷于处理多余的阿片类药物,而另一些患者则打算保留它们;(3)阿片类镇痛药物的可及性是可变的,但建立社区处方者关系对于出院后阿片类药物的再处方是重要的;(4)未来的关键改进建议包括常规出院后联系和必要时加强与医院的沟通。讨论和结论:我们的混合方法为脊柱手术后患者的疼痛和阿片类镇痛体验提供了丰富的见解。这些见解在寻求优化围手术期阿片类药物管理计划时非常有用,包括更好地满足患者消费者的需求。局限性包括在线焦点小组对年轻、社会经济地位较高的患者的潜在反应和选择偏差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patient experience of discharge opioid analgesia and care provision following spine surgery: A mixed methods study.

Background: Perioperative opioid stewardship programs are increasingly being introduced to guide responsible use around the time of surgery to reduce opioid-related harm to patients. However, patient experiences of perioperative opioid stewardship programs are underexplored.

Methods: We designed a mixed methods study to explore patients' experiences of perioperative opioid stewardship in the post-operative period following spine surgery. We performed evaluative action research, combining quality improvement and ethnographic methodologies. Our quantitative methods were retrospective medical record review and targeted survey research. Our qualitative methods were online focus groups. The quantitative data were analysed using descriptive statistics, chi-square, and rank sum testing. The focus group data underwent inductive thematic analysis.

Results: Our spine surgery cohort for the four-month study period included 101 patients. The median total discharge opioid dispensed was 75 mg [interquartile range 75-150 mg], with 30% of patients prescribed modified release opioids on discharge. A subset of patients (N = 14) participated in the online focus groups. The key themes that emerged from these sessions were (1) Supportive care delivery and rescue mechanisms were universally important to patient participants, providing great reassurance during their recovery; (2) Participants commonly believed opioid analgesia had an important role in recovery following spine surgery. Some patients were keen to dispose of surplus opioids whilst others intended to retain them; (3) Opioid analgesia access was variable, but established community prescriber relationships were important for post-discharge opioid re-prescription, and (4) The key future improvement suggestions included routine post-discharge contact and enhanced communication options back to the hospital if needed.

Discussion and conclusions: Our mixed methods approach provided rich insights into the pain and opioid analgesia experiences of patients following spine surgery. These insights are useful when seeking to optimise perioperative opioid stewardship programs including better meeting the needs of patient consumers. Limitations included potential response and selection bias for the online focus groups towards younger, higher socioeconomic status patients.

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来源期刊
British Journal of Pain
British Journal of Pain CLINICAL NEUROLOGY-
CiteScore
3.20
自引率
11.10%
发文量
42
期刊介绍: British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.
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