Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada.
BMC Health Serv Res. 2011 Oct 20;11:280. doi: 10.1186/1472-6963-11-280.
Work-related injuries result in considerable morbidity, as well as social and economic costs. Pain associated with these injuries is a complex, contested topic, and narcotic analgesics (NA) remain important treatment options. Factors contributing to NA utilization patterns are poorly understood. This qualitative study sought to characterize the factors contributing to NA utilization amongst injured workers from the perspectives of physicians and pharmacists.
The study employed concept mapping methodology, a structured process yielding a conceptual framework of participants' views on a particular topic. A visual display of the ideas/concepts generated is produced. Eligible physicians and pharmacists (n = 22) serving injured workers in the province of Ontario (Canada) were recruited via purposive sampling, and participated in concept mapping activities (consisting of brainstorming, sorting, rating, and map exploration). Participants identified factors influencing NA utilization, and sorted these factors into categories (clusters). Next, they rated the factors on two scales: 'strength of influence on NA over-utilization' and 'amenability to intervention'. During follow-up focus groups, participants refined the maps and discussed the findings and their implications.
82 factors were sorted into 7 clusters: addiction risks, psychosocial issues, social/work environment factors, systemic-third party factors, pharmacy-related factors, treatment problems, and physician factors. These clusters were grouped into 2 overarching categories/regions on the map: patient-level factors, and healthcare/compensation system-level factors. Participants rated NA over-utilization as most influenced by patient-level factors, while system-level factors were rated as most amenable to intervention. One system-level cluster was rated highly on both scales (treatment problems - e.g. poor continuity of care, poor interprofessional communication, lack of education/support for physicians regarding pain management, unavailability of multidisciplinary team-based care, prolonged wait times to see specialists).
Participants depicted factors driving NA utilization among injured workers as complex. Patient-level factors were perceived as most influential on over-utilization, while system-level factors were considered most amenable to intervention. This has implications for intervention design, suggesting that systemic/structural factors should be taken into account in order to address this important health issue.
工作相关伤害会导致相当大的发病率，以及社会和经济成本。与这些伤害相关的疼痛是一个复杂的、有争议的话题，麻醉性镇痛药（NA）仍然是重要的治疗选择。导致 NA 使用模式的因素了解甚少。这项定性研究旨在从医生和药剂师的角度描述导致受伤工人使用 NA 的因素。
该研究采用概念映射方法，这是一种生成参与者对特定主题的概念框架的结构化过程。生成想法/概念的视觉显示。符合条件的在安大略省（加拿大）为受伤工人服务的医生和药剂师（n=22）通过目的抽样招募，并参与概念映射活动（包括头脑风暴、分类、评分和地图探索）。参与者确定影响 NA 使用的因素，并将这些因素分类（聚类）。然后，他们对两个尺度上的因素进行评分：“对 NA 过度使用的影响强度”和“干预的适宜性”。在后续的焦点小组中，参与者完善了地图，并讨论了研究结果及其意义。
82 个因素被分为 7 个聚类：成瘾风险、心理社会问题、社会/工作环境因素、系统/第三方因素、药房相关因素、治疗问题和医生因素。这些聚类在地图上分为两个总体类别/区域：患者层面因素和医疗保健/补偿系统层面因素。参与者认为 NA 过度使用受患者层面因素的影响最大，而系统层面因素最适合干预。一个系统层面的聚类在两个尺度上都被评为高分（治疗问题 - 例如，护理连续性差、跨专业沟通不畅、缺乏医生疼痛管理教育/支持、缺乏多学科团队为基础的护理、专科医生就诊等待时间长）。
参与者描述了导致受伤工人使用 NA 的因素是复杂的。患者层面的因素被认为对过度使用的影响最大，而系统层面的因素被认为最适合干预。这对干预设计有影响，表明应该考虑系统/结构性因素，以解决这一重要的健康问题。
