Hart Oliver R, Uden Ruth M, McMullan James E, Ritchie Mark S, Williams Timothy D, Smith Blair H
1General Practitioner,Sloan Medical Practice,Sheffield,England.
2Management Consultant,pH Associates,Marlow,England.
Prim Health Care Res Dev. 2015 Apr;16(2):157-66. doi: 10.1017/S1463423614000140. Epub 2014 Mar 27.
To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective.
Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care.
Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients' records for three years from diagnosis ('newly diagnosed' patients) or for the most recent three years ('established' patients).
Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and 'newly diagnosed' patients were significantly more likely to visit their GP for pain management than 'established' patients. Although 'newly diagnosed' patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups.
This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use.
从初级保健的角度描述与腰痛或骨关节炎相关的慢性疼痛患者的治疗及转诊模式以及国民医疗服务体系的资源使用情况。
骨关节炎和腰痛是导致慢性疼痛最常见的两种使人衰弱的病因，造成高昂的健康和社会成本，在初级保健中尤为重要。了解当前对其管理的实践和资源使用情况将为卫生服务和教育需求以及未来护理的设计和优化提供依据。
通过初级保健记录识别出患有由腰痛或骨关节炎引起的慢性疼痛的成年人（≥18岁），进行多中心、回顾性、描述性研究。研究地点包括苏格兰、英格兰（两个）、北爱尔兰和威尔士的五家全科诊所。确定所有在2006年9月1日或之前被诊断为腰痛或骨关节炎且已接受三种或更多止痛药物处方的患者，然后随机抽取一个子样本，这些患者同意对其病历进行深入审查（n = 264）。从患者病历中回顾性收集自诊断起三年（“新诊断”患者）或最近三年（“确诊”患者）的慢性疼痛管理数据。
患者接受了各种各样的止痛药物，没有总体通用的处方模式。全科医生诊疗占资源使用的大部分，“新诊断”患者因疼痛管理而去看全科医生的可能性明显高于“确诊”患者。虽然“新诊断”患者向全科诊所外转诊的次数更多，但两组因疼痛管理而就诊二级医疗的次数相似。
这项回顾性研究证实了管理这些慢性疼痛病因的复杂性以及相关的高资源使用情况。它提供了处方和转诊模式以及资源使用的详细情况。
