Tamayo-Sarver Joshua H, Dawson Neal V, Cydulka Rita K, Wigton Robert S, Baker David W
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Ann Emerg Med. 2004 Apr;43(4):483-93. doi: 10.1016/j.annemergmed.2003.10.043.
The purpose of this study is to determine what factors influence emergency physicians' decisions to prescribe an opioid analgesic for 3 common, painful conditions.
We developed items thought to influence the decision to prescribe an opioid analgesic through a review of the literature, expert consultation, and interviews with practicing emergency physicians. We developed a baseline vignette and items expected to influence the decision for each of the 3 conditions: migraine, back pain, and ankle fracture. We surveyed 650 physicians randomly selected from the American College of Emergency Physicians. The influence of individual items was explored through a univariate analysis of the response distribution. Patterns were assessed by analytically creating scales.
We received responses from 398 (63%) of the 634 eligible physicians. Physicians' likelihoods of prescribing an opioid showed marked variability, with at least 10% of physicians saying they were unlikely and 10% of physicians saying they were likely to prescribe for each condition. Physician responses to individual pieces of clinical information, such as the patient requesting "something strong" for the pain, were also highly variable, with at least 10% of physicians saying they would be negatively influenced by this request and at least 10% saying they would be positively influenced by it.
Even when faced with identical case scenarios, physicians' decisions to prescribe opioid analgesics are highly variable. Moreover, the same clinical information, such as a patient requesting a strong analgesic, changes the likelihood of prescribing opioids in opposite directions for different physicians.
本研究旨在确定哪些因素会影响急诊医生针对3种常见疼痛状况开具阿片类镇痛药的决策。
我们通过文献回顾、专家咨询以及与执业急诊医生访谈，制定了被认为会影响开具阿片类镇痛药决策的项目。我们针对偏头痛、背痛和踝关节骨折这3种状况分别制定了一个基线病例 vignette 以及预期会影响决策的项目。我们对从美国急诊医师学会中随机选取的650名医生进行了调查。通过对反应分布的单变量分析来探究各个项目的影响。通过分析创建量表来评估模式。
在634名符合条件的医生中，我们收到了398名（63%）的回复。医生开具阿片类药物的可能性显示出显著差异，每种状况下至少有10%的医生表示不太可能开具，同时至少有10%的医生表示很可能开具。医生对个别临床信息的反应，比如患者要求使用“强效药物”止痛，也存在很大差异，至少有10%的医生表示他们会受到此要求的负面影响，至少有10%的医生表示会受到正面影响。
即使面对相同的病例场景，医生开具阿片类镇痛药的决策也存在很大差异。此外，相同的临床信息，比如患者要求使用强效镇痛药，对不同医生开具阿片类药物的可能性产生相反方向的影响。
