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远程指导改善初级保健提供者管理慢性疼痛的知识和能力:一项随机对照试验。

Telementoring for improving primary care provider knowledge and competence in managing chronic pain: A randomised controlled trial.

机构信息

School of Nursing and Health Studies, University of Washington Bothell, USA.

School of Medicine, University of Washington Seattle, USA.

出版信息

J Telemed Telecare. 2020 Jan-Feb;26(1-2):21-27. doi: 10.1177/1357633X18802978. Epub 2018 Sep 27.

Abstract

INTRODUCTION

Primary care providers are frequently unprepared to manage chronic pain adequately due in part to insufficient professional training. This study evaluated the effect of a telementoring intervention on knowledge and perceived competence related to chronic pain management.

METHODS

The study design was a cluster randomised controlled trial. Primary care clinics that were part of the University of Washington Medicine Telehealth network were the unit of randomization. Primary care providers comprised the intervention group (n = 23) and the control group (n = 18). Providers in the intervention group attended telementoring sessions through the TelePain programme and presented patient cases at the beginning and end of their enrolled patients’ 12-week study period. TelePain sessions included a didactic presentation and telementoring for specific patient cases by a panel of pain specialists from the disciplines of pain medicine, internal medicine, anaesthesiology, rehabilitation medicine, psychiatry, addiction medicine, nursing and complementary and integrative pain management. Providers’ baseline and end-of-study knowledge and perceived competence in managing chronic pain were assessed by three questionnaires: Knowledge and Attitudes Survey Regarding Pain, the KnowPain-12 and the Perceived Competence Scale.

RESULTS

Knowledge (Z = –0.34, p = 0.97 (Knowledge and Attitudes Survey Regarding Pain) and Z = 0.49, p = 0.62 (KnowPain-12)) and perceived competence (Z = –0.74, p = 0.46) did not increase for providers in the intervention group compared with providers in the control group. These providers attended on average 12.5 sessions (range 0–31) while participating in the study.

DISCUSSION

Further research is recommended to establish the effectiveness of this telementoring intervention.

摘要

简介

由于专业培训不足,初级保健提供者在很大程度上常常无法充分管理慢性疼痛。本研究评估了远程医疗指导干预对慢性疼痛管理相关知识和感知能力的影响。

方法

研究设计为一项群组随机对照试验。参与华盛顿大学医学远程医疗网络的初级保健诊所为随机分组单位。初级保健提供者构成干预组(n=23)和对照组(n=18)。干预组的提供者通过 TelePain 计划参加远程医疗指导会议,并在其纳入患者的 12 周研究期开始和结束时呈现患者病例。TelePain 会议包括由疼痛医学、内科、麻醉学、康复医学、精神病学、药物滥用医学、护理和补充与综合疼痛管理等学科的疼痛专家小组进行的专题介绍和远程医疗指导,用于特定患者病例。提供者在管理慢性疼痛方面的知识和感知能力的基线和期末评估是通过三个问卷进行的:疼痛知识和态度调查、KnowPain-12 和感知能力量表。

结果

与对照组的提供者相比,干预组的提供者的知识(Z=-0.34,p=0.97(疼痛知识和态度调查)和 Z=-0.49,p=0.62(KnowPain-12))和感知能力(Z=-0.74,p=0.46)并没有增加。这些提供者在参与研究期间平均参加了 12.5 次会议(范围 0-31 次)。

讨论

建议进行进一步的研究以确定这种远程医疗指导干预的有效性。

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