Chassany Olivier, Boureau François, Liard François, Bertin Philippe, Serrie Alain, Ferran Pierre, Keddad Karim, Jolivet-Landreau Isabelle, Marchand Serge
Département de la Recherche Clinique et du Développement de l'Assistance Publique, Hôpitaux de Paris, France.
J Rheumatol. 2006 Sep;33(9):1827-34. Epub 2006 May 15.
To evaluate the effects of a short interactive training program for general practitioners (GP) on pain management in patients with osteoarthritis (OA).
A multicenter, parallel-group study. GP were randomized to receive training on relationships and communication, pain evaluation, prescription, and negotiation of a patient contract or to a control group receiving a presentation about obtaining consent in trials. Outcomes were patient assessments of pain and functional ability. We invited 1500 GP to take part in the study. Those who volunteered to receive the training recruited outpatients from May 2001 to April 2002. Patients participating in the evaluation of the effects of the general practitioners' training had lower limb OA and pain on motion [> or = 40 mm on a visual analog scale (VAS)] and had indications for treatment with acetaminophen. The primary endpoint: sum of patient pain relief based on the daily VAS self-evaluation during the 2 weeks of the trial.
In total, 180 GP (84 trained, 96 nontrained) enrolled 842 patients (414 and 428, respectively). Mean baseline VAS pain was 63 +/- 14 mm. Patients in the trained-GP group had better overall pain relief (316 +/- 290 mm/day vs 265 +/- 243 mm; p < 0.0001), greater improvement in Lequesne and WOMAC scores (p < 0.0001), and better overall perception of treatment (p = 0.002). Acetaminophen use was slightly higher in the trained group; however, the difference in pain relief remained statistically significant (p = 0.0003) after adjustment for this difference.
This is the first study to demonstrate a positive effect of physician training on patients with a painful condition.
评估针对全科医生（GP）的短期互动培训项目对骨关节炎（OA）患者疼痛管理的效果。
一项多中心平行组研究。全科医生被随机分为两组，一组接受关于医患关系与沟通、疼痛评估、处方开具以及患者治疗协议协商方面的培训，另一组作为对照组，接受关于试验中获取同意书的讲座。观察指标为患者对疼痛和功能能力的评估。我们邀请了1500名全科医生参与该研究。那些自愿接受培训的医生在2001年5月至2002年4月期间招募门诊患者。参与全科医生培训效果评估的患者患有下肢骨关节炎且运动时疼痛[视觉模拟量表（VAS）评分≥40毫米]，并有使用对乙酰氨基酚治疗的指征。主要终点：基于试验2周期间每日VAS自我评估得出的患者疼痛缓解总和。
总共180名全科医生（84名接受培训，96名未接受培训）招募了842名患者（分别为414名和428名）。基线VAS疼痛平均值为63±14毫米。接受培训的全科医生组的患者总体疼痛缓解情况更好（316±290毫米/天对265±243毫米；p<0.0001），Lequesne和WOMAC评分改善更大（p<0.0001），对治疗的总体感知更好（p = 0.002）。接受培训的组对乙酰氨基酚的使用略多；然而，在对此差异进行调整后，疼痛缓解方面的差异仍具有统计学意义（p = 0.0003）。
这是第一项证明医生培训对疼痛性疾病患者有积极效果的研究。
