Donaldson Síne R, Harding Andrew M, Taylor Simone E, Vally Hassan, Greene Shaun L
Emergency Department, Austin Health, Melbourne, Victoria, Australia.
Department of Public Health, La Trobe University College of Science, Health and Engineering, Melbourne, Victoria, Australia.
Emerg Med Australas. 2017 Aug;29(4):400-406. doi: 10.1111/1742-6723.12772. Epub 2017 May 24.
The objective of this study was to evaluate the impact of an educational intervention on ED discharge opioid analgesic (OA) prescribing.
A brief, one-on-one, educational intervention was delivered to ED OA prescribers by an ED clinical champion. The percentage of patients receiving (i) written advice regarding appropriate oxycodone use, (ii) written or verbal advice regarding appropriate post-discharge follow up and (iii) written general practitioner notification that oxycodone had been prescribed were determined pre- and post-intervention, through review of electronic patient records and structured patient telephone interviews conducted 3-7 days after ED attendance. Secondary outcomes included total amount prescribed and use of non-OA therapies. ED OA prescribers were surveyed to evaluate perceived effectiveness and intervention acceptability.
A total of 30 ED OA prescribers received the 5-min intervention. Pre- and post-intervention, 80 and 81 patients were interviewed, respectively. Percentage of patients given written OA information increased from 10% to 22% (P = 0.04) and those receiving follow-up advice increased from 61 to 94% (P < 0.01). General practitioner notification of OA prescription increased from 15% to 88% (P < 0.01). Risk ratio for achieving all three end-points was 7.5 (95% confidence interval 1.8-32, P = 0.01). Median total amount of oxycodone prescribed/patient decreased from 100mg to 50mg (P = 0.04). Non-OA therapies were used by 49% of pre-intervention and 85% of post-intervention patients (P = <0.01). All ED OA prescribers agreed the intervention would change their prescribing practices; 70% deemed the intervention appropriate for delivery in their work environment.
A brief, one-on-one educational intervention targeting ED OA prescribers was well received by clinicians and associated with improved quality of OA prescribing.
本研究的目的是评估一项教育干预措施对急诊科出院时阿片类镇痛药（OA）处方的影响。
急诊科的一位临床骨干对急诊科OA处方医生进行了简短的一对一教育干预。通过查阅电子病历以及在患者急诊科就诊3 - 7天后进行的结构化电话访谈，确定干预前后接受以下内容的患者百分比：（i）关于羟考酮合理使用的书面建议；（ii）关于出院后适当随访的书面或口头建议；（iii）关于已开具羟考酮处方的书面全科医生通知。次要结果包括处方总量和非OA疗法的使用情况。对急诊科OA处方医生进行调查，以评估他们对干预效果的认知和干预的可接受性。
共有30名急诊科OA处方医生接受了5分钟的干预。干预前后分别对80名和81名患者进行了访谈。给予书面OA信息的患者百分比从10%增加到22%（P = 0.04），接受随访建议的患者从61%增加到94%（P < 0.01）。向全科医生通报OA处方的比例从15%增加到88%（P < 0.01）。实现所有三个终点的风险比为7.5（95%置信区间1.8 - 32，P = 0.01）。每位患者羟考酮处方的中位数总量从100毫克降至50毫克（P = 0.04）。干预前49%的患者和干预后85%的患者使用了非OA疗法（P = <0.01）。所有急诊科OA处方医生都认为该干预会改变他们的处方习惯；70%的人认为该干预适合在他们的工作环境中实施。
针对急诊科OA处方医生的简短一对一教育干预受到临床医生的好评，并与OA处方质量的提高相关。
