McCalmont Jean C, Jones Kim D, Bennett Robert M, Friend Ronald
Nursing, Oregon Health & Science University, Portland, Oregon.
Psychology, Stony Brook University, Stony Brook, New York.
J Opioid Manag. 2018 Mar-Apr;14(2):103-116. doi: 10.5055/jom.2018.0437.
(1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations.
A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training.
The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers' profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9).
Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.
（1）评估医疗服务提供者对慢性非癌性疼痛（CNCP）管理的经验和知识。（2）评估医疗服务提供者对疾病控制与预防中心（CDC）2016年慢性疼痛阿片类药物处方指南的应用情况。（3）评估2016年CDC指南对医疗服务提供者管理CNCP的信心以及对CDC建议的遵循情况的影响。
对417名俄勒冈州的处方开具者进行了一项基于网络的横断面调查，这些开具者被分为三个继续医学教育（CME）组，分别是接受最少（0 - 3小时）、中等（4 - 10小时）和高（≥11小时）培训时长的组。
三个CME组在使用CDC阿片类药物推荐做法（29.4、34.2、38.8；p = 0.001；范围0 - 50）、阿片类药物转换信心（5.5、6.5、7.4；p < 0.001；范围0 - 9）以及疼痛管理信心（5.5、5.9、6.9；p < 0.001，范围0 - 9）方面均有所增加。使用CDC推荐做法的医疗服务提供者略多于未使用者（57%对43%）。然而，CME组在CDC做法的应用上存在显著差异（42%对57%对72%；p < 0.001）。医疗服务提供者的职业（医生与执业护士[NP]）和地理位置（城市与农村）在推荐做法的使用或疼痛管理的总体信心方面均未显示出差异（所有p > 0.05）；然而，医生在阿片类药物剂量转换方面比NP略更有信心（6.9对5.9；p < 0.001，范围0 - 9）。
近期CME培训时长越高，对医疗服务提供者在疼痛管理方面的信心以及对CDC推荐做法的应用有积极益处。NP和农村地区的医疗服务提供者在对CDC做法的信心和遵循方面与医生和城市地区的同行相当，仅有一些小的例外情况。
