UMR INSERM 1027, University of Toulouse III, Toulouse, France.
UMR INSERM 1027, University of Toulouse III, Toulouse, France; Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
J Am Med Dir Assoc. 2018 Dec;19(12):1118-1123.e2. doi: 10.1016/j.jamda.2018.09.031.
To determine whether an intervention based on education and professional support to nursing home (NH) staff would decrease the number of residents with a pain complaint, and to determine whether the intervention would improve pain management.
Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong intervention group consisting in audit, feedback, and collaborative work on quality indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting in audit and feedback only.
One hundred fifty-nine NHs located in France.
A subgroup of 3722 residents.
Information on pain complaint and pain-related covariates at the resident-related and at the NH level were recorded by NH staff at baseline and 18 months later. These covariates were included in a mixed-effects logistic regression on resident's pain complaint. Pain management was compared between intervention groups by chi-square tests.
A greater reduction of residents with a pain complaint after the strong intervention (odds ratio 0.69, 95% confidence interval 0.53, 0.90) and a better pain management (47.6% gold standard, vs 30.6% in the LIG, P < .001) than controls.
CONCLUSION/IMPLICATIONS: Combining educational and organizational measures, evaluating pain as a patient-reported outcome and as a process endpoint, and implementing a broad-spectrum intervention were original approaches to improve quality of care in NHs. Our results support nonspecific, collaborative, educational, and organizational interventions in NHs to decrease residents' pain complaint and improve pain management.
确定基于教育和专业支持的干预措施是否会减少有疼痛抱怨的居民人数，并确定干预措施是否会改善疼痛管理。
非随机对照试验。养老院（NH）被非随机分配到强化干预组或轻度干预组（LIG）。强化干预组包括审计、反馈和与医院老年病学家合作制定质量指标，而 LIG 仅包括审计和反馈。
法国的 159 家 NH。
3722 名居民的一个亚组。
NH 工作人员在基线和 18 个月后记录居民相关和 NH 级别的疼痛抱怨和与疼痛相关的协变量信息。这些协变量被纳入居民疼痛抱怨的混合效应逻辑回归中。通过卡方检验比较干预组之间的疼痛管理情况。
强化干预后疼痛抱怨减少的居民比例更大（优势比 0.69，95%置信区间 0.53，0.90），疼痛管理更好（黄金标准为 47.6%，LIG 为 30.6%，P<.001）。
结论/意义：结合教育和组织措施，将疼痛评估为患者报告的结果和过程终点，并实施广谱干预，是改善 NH 护理质量的创新方法。我们的结果支持 NH 中针对非特定、协作、教育和组织干预措施，以减少居民的疼痛抱怨并改善疼痛管理。
