初级保健提供者对老年慢性非癌痛患者开具阿片类药物的看法：一项定性研究。
Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: a qualitative study.
机构信息
Department of Internal Medicine, Virginia Mason Medical Center, Seattle, WA, USA.
出版信息
BMC Geriatr. 2011 Jul 14;11:35. doi: 10.1186/1471-2318-11-35.
BACKGROUND
The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.
METHODS
Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.
RESULTS
Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.
CONCLUSIONS
Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.
背景
阿片类药物被用于治疗慢性非癌痛，但仍存在争议。目前，关于老年患者中医疗保健提供者对这种治疗方法的态度和看法的信息很少。本研究旨在描述初级保健提供者对治疗老年慢性疼痛开具阿片类药物的经验、态度，以及对阿片类药物处方的障碍和促进因素的看法。
方法
在纽约市的两个学术附属初级保健诊所和三个社区健康中心，共进行了 6 次焦点小组讨论，共有 23 名医生和 3 名护士参加。焦点小组进行了录音和转录。使用定向内容分析法对数据进行分析；使用 NVivo 软件辅助识别和量化主题。
结果
大多数参与者（96%）曾为一些患有慢性疼痛的老年患者开具阿片类药物治疗，但并非作为一线治疗。提供者列举了多种障碍，包括担心造成伤害、疼痛的主观性、缺乏教育、转换阿片类药物的问题以及污名化。新的障碍包括患者/家属不愿意尝试阿片类药物以及对家庭成员/照顾者滥用阿片类药物的担忧。证实治疗益处的研究、评估风险和/或共病药物剂量的有效工具、改进的转换方法、患者教育和同伴支持可以促进阿片类药物的开具。参与者在提供姑息治疗或临终关怀时比在治疗慢性疼痛患者时更愿意使用阿片类药物，并且在管理慢性疼痛方面感到非常沮丧。
结论
提供者认为为患有慢性疼痛的老年患者开具阿片类药物存在多种障碍，并且谨慎使用这些药物。确定这些药物的长期安全性和疗效，制定更好的处方方法，并实施提供者和患者教育干预措施，可能有助于改善晚年慢性疼痛的管理。
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