Jacobsen Ramune, Møldrup Claus, Christrup Lona
Section for Health Services Research, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Denmark.
J Opioid Manag. 2010 Jul-Aug;6(4):259-68. doi: 10.5055/jom.2010.0024.
The aim of this study was to describe the rationale behind the choice of fentanyl administration forms among Danish general practitioners (GPs).
Thirty-eight Danish GPs were contacted via an Internet survey system to perform a Delphi survey. In the brainstorming phase, the main reasons for prescribing and not prescribing fentanyl patches, oral transmucosal systems (OTFCs), and nasal sprays were identified. In the second phase, GPs were asked to rate the importance of each reason.
Thirty-three GPs responded in the brainstorming phase, and 33 and 31 in two rating rounds, respectively. The most important reason to choose fentanyl patches was that patients' clinical condition did not allow them to take analgesia orally. OTFCs were primarily seen as a self-administrative alternative to injections in case of breakthrough pain. The main reasons for not choosing OTFCs were intolerance to fentanyl and price. The most important possible rationale to choose fentanyl nasal spray was easy administration. The most important possible reasons to not choose fenanyl nasal spray were application side effects.
The rationale behind the choice of administration form with fentanyl partly differed from those overviewed in the literature. Fentanyl nasal spray was seen as a better option for treatment of breakthrough pain among terminally ill patients if compared with OTFCs.
本研究旨在描述丹麦全科医生选择芬太尼给药形式背后的基本原理。
通过互联网调查系统联系了38名丹麦全科医生以进行德尔菲调查。在头脑风暴阶段，确定了开具和不开具芬太尼透皮贴剂、口腔黏膜给药系统（OTFC）和鼻喷雾剂的主要原因。在第二阶段，要求全科医生对每个原因的重要性进行评分。
在头脑风暴阶段有33名全科医生做出回应，在两轮评分中分别有33名和31名做出回应。选择芬太尼透皮贴剂的最重要原因是患者的临床状况不允许他们口服镇痛药。OTFC主要被视为在爆发性疼痛情况下替代注射的一种自我给药方式。不选择OTFC的主要原因是对芬太尼不耐受和价格因素。选择芬太尼鼻喷雾剂的最重要可能理由是给药方便。不选择芬太尼鼻喷雾剂的最重要可能原因是应用时的副作用。
芬太尼给药形式选择背后的基本原理与文献中概述的部分不同。与OTFC相比，芬太尼鼻喷雾剂被视为治疗晚期患者爆发性疼痛的更好选择。
