Peacock Amy, Nielsen Suzanne, Bruno Raimondo, Campbell Gabrielle, Larance Briony, Degenhardt Louisa
School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Pain Med. 2016 Nov;17(11):2003-2016. doi: 10.1093/pm/pnw109. Epub 2016 Jun 10.
Rates of chronic non-cancer pain are increasing worldwide, with concerns regarding poorer access to specialist treatment services in remote areas. The current study comprised the first in-depth examination of use and barriers to access of health services in Australia according to remoteness.
A cohort of Australian adults prescribed pharmaceutical opioids for chronic non-cancer pain (n = 1,235) were interviewed between August 2012 and April 2014, and grouped into 'major city' (49%), 'inner regional' (37%), and 'outer regional/remote' (14%) according to the Australian Standard Geographical Classification based on postcode. Multinomial logistic regression analyses were conducted to determine geographical differences in socio-demographic and clinical characteristics, health service use, and perceived barriers to health service access.
The 'inner regional group' and 'outer regional/remote group' were more likely to be male (relative risk ratio (RRR)=1.38,95%CI 1.08-1.77 and RRR = 1.60, 95%CI 1.14-2.24) and have no private health insurance (RRR = 1.53, 95%CI 1.19-1.97 and RRR = 1.65, 95%CI 1.16-2.37) than the 'major city group' (49%). However, the 'inner regional group' reported lower pain severity and better mental health relative to the 'major city group' = 0.92, 95%CI 0.86-0.98 and RRR = 1.02, 95%CI 1.01-1.03, respectively). Although rates of health service access were generally similar, the 'outer regional/remote group' were more likely to report client-practitioner communication problems (RRR = 1.57, 95%CI 1.03-2.37), difficulties accessing specialists (RRR = 1.56, 95%CI 1.01-2.39), and perception of practitioner lack of confidence in prescribing pain medication (RRR = 1.73, 1.14-2.62), relative to both groups.
Perceived communication, access, and financial barriers to healthcare indicate the need for increased efforts to address geographic inequality in pain treatment.
慢性非癌性疼痛的发病率在全球范围内呈上升趋势，人们担心偏远地区获得专科治疗服务的机会较少。本研究首次对澳大利亚不同偏远程度地区卫生服务的使用情况和获取障碍进行了深入调查。
2012年8月至2014年4月间，对一组因慢性非癌性疼痛而开具了阿片类药物处方的澳大利亚成年人（n = 1235）进行了访谈，并根据基于邮政编码的澳大利亚标准地理分类，将他们分为“大城市”组（49%）、“内地区域”组（37%）和“外地区域/偏远”组（14%）。进行多项逻辑回归分析，以确定社会人口统计学和临床特征、卫生服务使用情况以及卫生服务获取方面的感知障碍的地理差异。
与“大城市”组（49%）相比，“内地区域”组和“外地区域/偏远”组男性比例更高（相对风险比（RRR）= 1.38，95%置信区间1.08 - 1.77和RRR = 1.60，95%置信区间1.14 - 2.24），且没有私人医疗保险的比例更高（RRR = 1.53，95%置信区间1.19 - 1.97和RRR = 1.65，95%置信区间1.16 - 2.37）。然而，与“大城市”组相比，“内地区域”组报告的疼痛严重程度较低，心理健康状况较好（分别为RRR = 0.92，95%置信区间0.86 - 0.98和RRR = 1.02，95%置信区间1.01 - 1.03）。尽管卫生服务获取率总体相似，但与其他两组相比，“外地区域/偏远”组更有可能报告医患沟通问题（RRR = 1.57，95%置信区间1.03 - 2.37）、看专科医生困难（RRR = 1.56，95%置信区间1.01 - 2.39）以及认为医生对开具止痛药缺乏信心（RRR = 1.73，1.14 - 2.62）。
对医疗保健的沟通、获取和经济障碍的感知表明，需要加大力度解决疼痛治疗中的地理不平等问题。
