Kelly Sharon, Johnson Giffe T, Harbison Raymond D
Center for Environmental and Occupational Risk Analysis and Management, College of Public Health, University of South Florida, Tampa, US.
J Emerg Trauma Shock. 2016 Apr-Jun;9(2):58-63. doi: 10.4103/0974-2700.179454.
The purpose of this study was to elicit the opinions of Emergency Department (ED) physicians, currently practicing in the United States, regarding the impact of economic and regulatory factors on their management of patients exhibiting "drug seeking" behavior.
A descriptive, cross-sectional study, utilizing a convenience sample of ED physicians located in Florida and Georgia was conducted for a period of 2 months. The inclusion criteria specified that any ED physician, currently practicing within the United States, could participate.
Of the ED physicians surveyed (n = 141), 71% reported a perceived pressure to prescribe opioid analgesics to avoid administrative and regulatory criticism and 98% related patient satisfaction scores as being too highly emphasized by reimbursement entities as a means of evaluating their patient management. Rising patient volumes and changes in the healthcare climate were cited by ED physicians as impacting their management of patients exhibiting "drug seeking" behavior.
The ED physician faces unique challenges in changing healthcare and economic climates. Requirements to address pain as the "fifth vital sign," patient satisfaction based reimbursement metrics and an economically driven rise in ED patient volume, may have inadvertently created an environment conducive to exploitation by prescription opioid abusers. There is an identified need for the development of continuing medical education and standardized regulatory and legislative protocols to assist ED physicians in the appropriate management of patients exhibiting "drug seeking" behavior.
本研究旨在了解目前在美国执业的急诊科医生对于经济和监管因素对其管理表现出“药物成瘾性寻药行为”患者的影响的看法。
采用描述性横断面研究，以位于佛罗里达州和佐治亚州的急诊科医生为便利样本，为期2个月。纳入标准规定，任何目前在美国执业的急诊科医生均可参与。
在接受调查的急诊科医生（n = 141）中，71%报告称存在开具阿片类镇痛药以避免行政和监管批评的压力，98%认为报销实体过于强调患者满意度评分作为评估其患者管理的一种方式。急诊科医生指出，患者数量增加和医疗环境变化影响了他们对表现出“药物成瘾性寻药行为”患者的管理。
急诊科医生在不断变化的医疗和经济环境中面临独特挑战。将疼痛作为“第五生命体征”来处理的要求、基于患者满意度的报销指标以及经济驱动导致的急诊科患者数量增加，可能无意中营造了一个有利于处方阿片类药物滥用者利用的环境。明确需要开展继续医学教育，并制定标准化的监管和立法方案，以协助急诊科医生妥善管理表现出“药物成瘾性寻药行为”的患者。
