Gellatly Judith, Pelikan Gosia, Wilson Paul, Woodward-Nutt Kate, Spence Michael, Jones Anthony, Lovell Karina
NIHR CLAHRC Greater Manchester, Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Six Degrees Social Enterprise, Salford, UK.
BMC Fam Pract. 2018 Sep 1;19(1):151. doi: 10.1186/s12875-018-0838-y.
Chronic widespread pain (CWP) is a major public health problem. Many people experiencing CWP experience mental health problems such as anxiety or depression. Complete relief of skeletal and body pain symptoms is unlikely but with appropriate treatment the impact upon quality of life, functioning and mental health symptoms can be reduced. Cognitive behavioural therapy (CBT) is widely used for a range of health conditions and can have short and long-term improvements in patients with CWP. This research aimed to explore, from a professional stakeholder perspective, the implementation of a local Pain Platform offering a stepped care approach for interventions including telephone delivered CBT (T-CBT).
Fourteen professional stakeholders holding various roles across primary and secondary care services within the Pain Platform took part in semi-structured interviews. Their views and experiences of the implementation of the Pain Platform were explored. Interviews were recorded, transcribed verbatim and analysed according to Normalisation Process Theory (NPT).
Professional stakeholders were positive about the Pain Platform and its potential to overcome previously identified existing access issues to psychological interventions for CWP patients. It was considered a valuable part of ensuring that patients' preferences and needs are more readily addressed. In some circumstances, however, introducing psychological interventions to patients was considered challenging and the introduction of new referral processes was raised concerns. To ensure sustainability more work is required to reduce professional isolation and ensure efficient referral procedures between primary and secondary care services are established to reduce concerns over issues related to clinical governance and potential risk to patient.
The findings provide professional insight into the key challenges of introducing a Pain Platform incorporating psychological support across primary and secondary care services within a local service. These included development of sustainable procedures and closer working relationships. Areas requiring future development are identified.
慢性广泛性疼痛（CWP）是一个重大的公共卫生问题。许多患有CWP的人会经历焦虑或抑郁等心理健康问题。完全缓解骨骼和身体疼痛症状不太可能，但通过适当的治疗，可以减轻对生活质量、功能和心理健康症状的影响。认知行为疗法（CBT）广泛应用于一系列健康状况，对CWP患者可产生短期和长期的改善。本研究旨在从专业利益相关者的角度，探索当地疼痛平台的实施情况，该平台提供包括电话认知行为疗法（T-CBT）在内的分级护理干预方法。
疼痛平台内参与初级和二级护理服务的14名担任不同角色的专业利益相关者参加了半结构化访谈。探讨了他们对疼痛平台实施的看法和经验。访谈进行了录音，逐字转录，并根据规范化过程理论（NPT）进行分析。
专业利益相关者对疼痛平台及其克服先前确定的CWP患者心理干预现有获取问题的潜力持积极态度。它被认为是确保更能满足患者偏好和需求的重要组成部分。然而，在某些情况下，向患者引入心理干预被认为具有挑战性，并且新的转诊流程的引入引发了担忧。为确保可持续性，需要开展更多工作以减少专业人员的孤立感，并确保在初级和二级护理服务之间建立有效的转诊程序，以减少对临床治理问题和患者潜在风险的担忧。
研究结果为在当地服务中引入一个整合初级和二级护理服务中心理支持的疼痛平台的关键挑战提供了专业见解。这些挑战包括制定可持续的程序和建立更紧密的工作关系。确定了未来需要发展的领域。
