Hadi Muhammad Abdul, Alldred David Phillip, Briggs Michelle, Marczewski Kathryn, Closs S José
School of Healthcare, University of Leeds, Leeds, UK.
Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK.
BMJ Open. 2017 Jun 12;7(6):e016454. doi: 10.1136/bmjopen-2017-016454.
To identify barriers to effective pain management encountered by patients with chronic pain within the UK's National Health Service (NHS).
Secondary analysis of face-to-face, semistructured qualitative interviews using thematic analysis.
A community-based chronic pain clinic jointly managed by a nurse and pharmacist located in the North of England.
Nineteen adult (>18 years) patients with chronic pain discharged from a pain clinic, with the ability to understand and speak the English language.
In general, patients were highly disappointed with the quality of pain management services provided both within primary and secondary care, and consequently were willing to seek private medical care. Barriers to effective pain management were divided into two main themes: healthcare professional-related and health systems-related. Three subthemes emerged under healthcare professionals-related barriers, namely (1) healthcare professionals' lack of interest and empathy, (2) general practitioners' (GP) lack of specialised knowledge in pain management and (3) lack of communication between healthcare professionals. Three subthemes emerged under health system-related barriers: (1) long waiting time for appointments in secondary care, (2) short consultation times with GPs and (3) lack of an integrated multidisciplinary approach.
The patients expressed a clear desire for the improved provision and quality of chronic pain management services within the NHS to overcome barriers identified in this study. An integrated holistic approach based on a biopsychosocial model is required to effectively manage pain and improve patient satisfaction. Future research should explore the feasibility, effectiveness and cost-effectiveness of integrated care delivery models for chronic pain management within primary care.
确定英国国家医疗服务体系（NHS）中慢性疼痛患者在有效疼痛管理方面遇到的障碍。
采用主题分析法对面对面的半结构化定性访谈进行二次分析。
位于英格兰北部的一家由护士和药剂师联合管理的社区慢性疼痛诊所。
19名从疼痛诊所出院的成年（>18岁）慢性疼痛患者，具备理解和说英语的能力。
总体而言，患者对初级和二级护理中提供的疼痛管理服务质量非常失望，因此愿意寻求私人医疗服务。有效疼痛管理的障碍分为两个主要主题：与医疗专业人员相关的和与卫生系统相关的。在与医疗专业人员相关的障碍下出现了三个子主题，即（1）医疗专业人员缺乏兴趣和同理心，（2）全科医生（GP）在疼痛管理方面缺乏专业知识，以及（3）医疗专业人员之间缺乏沟通。在与卫生系统相关的障碍下出现了三个子主题：（1）二级护理预约等待时间长，（2）与全科医生的咨询时间短，以及（3）缺乏综合多学科方法。
患者明确表示希望改善NHS内慢性疼痛管理服务的提供和质量，以克服本研究中确定的障碍。需要一种基于生物心理社会模型的综合整体方法来有效管理疼痛并提高患者满意度。未来的研究应探讨初级护理中慢性疼痛管理综合护理提供模式的可行性、有效性和成本效益。
