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镰状细胞病患者对急诊科疼痛管理的看法。

Sickle cell disease patients' perceptions of emergency department pain management.

机构信息

St. Jude Children's Research Hospital, Department of Psychology, Memphis, TN 38105, USA.

出版信息

J Natl Med Assoc. 2012 Sep-Oct;104(9-10):449-54. doi: 10.1016/s0027-9684(15)30199-1.

Abstract

Patients with sickle cell disease (SCD) experience painful crises that often require admission to the emergency department (ED) for pain management. Factors such as ED overcrowding and negative perception and stigmatization of SCD may impact patients' perceptions of the quality of pain management in the ED. Data from a multisite prospective cohort study was assessed to determine whether demographic (age and sex), clinical (time to administration of initial analgesia, number of analgesic doses, discharge disposition, and clinical site), or interpersonal factors (separately measured perceptions of being treated with trust and respect by ED triage nurses, nurses, and physicians) were associated with patient ratings of their pain management in the ED. Patients were adults with SCD seen at 3 EDs (2 urban and 1 rural). Demographic and clinical information was derived from medical record review; interpersonal and ED pain management ratings were derived from interviews conducted 1 week post ED visit. A total of 209 interviews by 98 patients were analyzed. Results indicated significant differences among the ED sites on the demographic, clinical, and interpersonal factors. Overall, patients reported being treated with trust and respect by ED clinicians. Adjusted logistic regression analyses indicated that ED clinical site 1 (odds ratio [OR], 10.42; 95% confidence interval [Cl], 1.44-7.36) and being treated with trust and respect by the ED physician (OR, 25.53; 95% CI, 2.07-314.96) predicted good ED pain management ratings. Interpersonal health care experiences may be an important indicator of patient satisfaction and quality of care received by patients with SCD in the ED.

摘要

患有镰状细胞病 (SCD) 的患者会经历疼痛危机,通常需要到急诊部 (ED) 进行疼痛管理。ED 过度拥挤以及对 SCD 的负面看法和污名化等因素可能会影响患者对 ED 疼痛管理质量的感知。评估一项多地点前瞻性队列研究的数据,以确定人口统计学因素(年龄和性别)、临床因素(初始镇痛药物给药时间、镇痛药物剂量、出院处置和临床地点)或人际因素(单独测量的 ED 分诊护士、护士和医生对患者的信任和尊重程度)是否与患者对 ED 疼痛管理的评价相关。患者为在 3 个 ED(2 个城市和 1 个农村)就诊的 SCD 成年患者。人口统计学和临床信息来自病历审查;人际和 ED 疼痛管理评分来自 ED 就诊后 1 周进行的访谈。共分析了 98 名患者的 209 次访谈。结果表明,ED 地点之间在人口统计学、临床和人际因素方面存在显著差异。总体而言,患者报告称他们受到 ED 临床医生的信任和尊重。调整后的逻辑回归分析表明,ED 临床科室 1(优势比 [OR],10.42;95%置信区间 [CI],1.44-7.36)和得到 ED 医生的信任和尊重(OR,25.53;95%CI,2.07-314.96)预测 ED 疼痛管理评分良好。人际医疗保健体验可能是 SCD 患者在 ED 中满意度和护理质量的重要指标。

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