School of Nursing and Midwifery, Epworth/Deakin Centre For Clinical Nursing Research, Faculty Health, Deakin University, Burwood, Victoria, Australia.
Clin J Pain. 2012 Mar-Apr;28(3):187-94. doi: 10.1097/AJP.0b013e3182290d56.
The objective of the study was to examine patients' experiences of pain in Hospital in the Home (HITH) programs and identify the issues related to providing optimal pain management for acute care patients in the home environment.
A descriptive survey of patients' experience of pain and pain management in 3 HITH programs in metropolitan Melbourne, Australia (n=359). Data were collected by telephone interview using a modified version of The American Pain Society's Patient Outcome Questionnaire. Patients were interviewed 48 to 72 hours after admission to the HITH program. Consecutive, adult, acute care patients were invited to participate in the study. Patients who had previously participated or had communication difficulties unable to be overcome with the assistance of an interpreter were excluded.
Sixty-nine percent of patients interviewed experienced pain at home and 86% of these patients had experienced pain in the 24 hours before the interview. Over half (56%) of the patients had experienced moderate-to-severe worst pain in the previous 24 hours and 33% reported moderate-to-severe pain as their average pain experience. Two hundred thirty-two (93.2%) of the 250 patients who experienced pain had pain in hospital before being transferred to HITH. Of these patients, 52.2% (n=132) were prescribed analgesics to take home with them; the remaining 118 patients experiencing pain were not prescribed analgesics and either sourced analgesics once home (n=81, 68.1%) or did not take any analgesics (n=38, 31.9%).
Treatment of pain at home was suboptimal with patients experiencing moderate-to-severe pain and discomfort during the treatment phase of their illness. Lack of appropriate discharge planning strategies meant that patients went home without adequate analgesia and use of nonprescribed pain medication was common. The number of patients transferred home without analgesics indicates a worrying underrecognition of the need for analgesia in this care context and poses a risk to patient safety that is no less significant because patients are at home.
本研究旨在探讨住院患者在家中（HITH）计划中经历的疼痛情况，并确定在家庭环境中为急性护理患者提供最佳疼痛管理相关的问题。
对澳大利亚墨尔本大都市的 3 个 HITH 计划中 359 名患者的疼痛经历和疼痛管理情况进行描述性调查。使用美国疼痛协会患者结局问卷的修订版通过电话访谈收集数据。患者在 HITH 计划入院后 48 至 72 小时接受访谈。邀请连续的、成年的、急性护理患者参加研究。之前参加过或由于沟通困难而无法通过口译员的帮助解决的患者被排除在外。
接受访谈的 69%的患者在家中经历疼痛，其中 86%的患者在访谈前 24 小时内经历过疼痛。超过一半（56%）的患者在过去 24 小时内经历过中度至重度最剧烈疼痛，33%的患者报告中度至重度疼痛是他们的平均疼痛体验。在被转至 HITH 之前，250 名经历疼痛的患者中有 232 名（93.2%）在医院经历过疼痛。在这些患者中，52.2%（n=132）被开了止痛药带回家；其余 118 名经历疼痛的患者未开止痛药，要么回家后自行获取止痛药（n=81，68.1%），要么根本不吃任何止痛药（n=38，31.9%）。
家庭中的疼痛治疗效果不佳，患者在疾病治疗阶段经历中度至重度疼痛和不适。缺乏适当的出院计划策略意味着患者回家时没有足够的止痛药物，并且经常使用非处方止痛药。有那么多患者没有止痛药就被送回家，这表明在这种护理环境中对疼痛治疗需求的认识不足令人担忧，这对患者安全构成了风险，而且并不比患者在家时的风险小。
