Fagan Mark J, Chen Joyce T, Diaz Joseph A, Reinert Steven E, Stein Michael D
Division of General Internal Medicine, Department of Medicine Brown Medical School, Providence, RI 02903, USA.
Clin J Pain. 2008 Jan;24(1):35-8. doi: 10.1097/AJP.0b013e318156dadf.
Little is known about whether internal medicine residents find pain management agreements (PMAs) useful or whether PMA use is associated with more positive attitudes toward patients with chronic noncancer pain (CNCP).
We surveyed all internal medicine residents at Rhode Island Hospital regarding whether they found PMAs useful, what percentage of their patients taking chronic opioids had a signed PMA, and their attitudes toward and experiences with managing CNCP.
Survey response rate was 89% (110/124). Ninety percent of respondents reported finding PMAs useful. A majority of respondents reported that PMAs were at least somewhat helpful for reducing multiple prescribers (76%), reducing requests for early refills (67%), reducing calls and pages from patients (57%), making it easier to discuss potential problems associated with chronic opioid use (73%), and making it easier to identify patients who are abusing pain medications (66%). Residents who reported greater use of PMAs reported a greater sense of preparation (r=0.20, P=0.04), greater confidence (r=0.18, P=0.06), and a greater sense of reward (r=0.24, P=0.02) for managing CNCP. In a multivariate analysis, PMA use was significantly associated with greater sense of preparation and greater sense of reward for managing CNCP.
Among internal medicine residents, PMA use was associated with more positive attitudes toward CNCP management.
关于内科住院医师是否认为疼痛管理协议（PMA）有用，以及PMA的使用是否与对慢性非癌性疼痛（CNCP）患者的更积极态度相关，目前所知甚少。
我们对罗德岛医院的所有内科住院医师进行了调查，询问他们是否认为PMA有用，服用慢性阿片类药物的患者中有多少百分比签署了PMA，以及他们对管理CNCP的态度和经验。
调查回复率为89%（110/124）。90%的受访者表示认为PMA有用。大多数受访者报告称，PMA至少在一定程度上有助于减少多个开方者（76%）、减少提前续方的请求（67%）、减少患者的电话和传呼（57%）、更便于讨论与慢性阿片类药物使用相关的潜在问题（73%）以及更便于识别滥用止痛药物的患者（66%）。报告更多使用PMA的住院医师表示，在管理CNCP方面有更强的准备感（r=0.20，P=0.04）、更强的信心（r=0.18，P=0.06）和更强的成就感（r=0.24，P=0.02）。在多变量分析中，PMA的使用与管理CNCP的更强准备感和更强成就感显著相关。
在内科住院医师中，PMA的使用与对CNCP管理的更积极态度相关。
