Dueñas María, Salazar Alejandro, Sánchez Modesto, De Sola Helena, Ojeda Begoña, Failde Inmaculada
Salus Infirmorum Faculty of Nursing, University of Cádiz, Cádiz, Spain.
Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cádiz, Spain.
Pain Pract. 2018 Jan;18(1):38-47. doi: 10.1111/papr.12579. Epub 2017 May 5.
To determine the use of clinical practice guidelines (CPGs) for chronic pain (CP) management; analyze the effects of training in pain and the attitudes of physicians toward pain and CP patients on the adherence to these CPGs; and assess the impact of adherence to CPGs on patient care.
This was a cross-sectional study in a sample of physicians involved in CP patient management. Information on the use of CPGs for CP management, their training in pain, and their attitudes toward pain, patients, and patient care was collected. Descriptive and bivariate analyses were performed, and a multinomial logistic regression model was constructed to analyze factors associated with the use of CPGs.
Of the 257 physicians surveyed, 46.6% were physiatrists, 26.7% were general practitioners, and 26.7% were medical oncologists. Although 96.5% claimed to have received training in pain, only 10.1% had received college training, and 76.3% expressed having gaps in their knowledge; 53.9% stated they applied CPGs often/always, and 12.5% rarely/never. Limited knowledge on pain, reduced involvement in training activities, more negative attitudes toward patients, and having experienced CP were the factors related to reduced adherence to CPGs, especially among the youngest respondents. The greater the use of CPGs, the better the patient care was.
Access to scientific information and specialized training are factors related to the use of CPGs for pain treatment. Therefore, the inclusion of CP training in university and during medical specialty training will be essential measures to improve adherence to CPG, thereby improving patient care and pain control.
确定临床实践指南（CPG）在慢性疼痛（CP）管理中的应用情况；分析疼痛培训以及医生对疼痛和CP患者的态度对这些CPG依从性的影响；并评估CPG依从性对患者护理的影响。
这是一项针对参与CP患者管理的医生样本的横断面研究。收集了有关CPG在CP管理中的使用情况、他们的疼痛培训情况以及他们对疼痛、患者和患者护理的态度的信息。进行了描述性和双变量分析，并构建了多项逻辑回归模型来分析与CPG使用相关的因素。
在接受调查的257名医生中，46.6%是物理治疗师，26.7%是全科医生，26.7%是医学肿瘤学家。尽管96.5%的人声称接受过疼痛培训，但只有10.1%的人接受过大学培训，76.3%的人表示自己知识存在欠缺；53.9%的人表示他们经常/总是应用CPG，12.5%的人很少/从不应用。对疼痛的知识有限、参与培训活动较少、对患者态度更消极以及曾经历过CP是与CPG依从性降低相关的因素，尤其是在最年轻的受访者中。CPG的使用越多，患者护理越好。
获取科学信息和接受专业培训是与使用CPG进行疼痛治疗相关的因素。因此，在大学和医学专科培训期间纳入CP培训将是提高CPG依从性的重要措施，从而改善患者护理和疼痛控制。
