Major-Monfried Hannah, DeCherrie Linda V, Wajnberg Ania, Zhang Meng, Kelley Amy S, Ornstein Katherine A
1 Department of Pediatrics, Columbia University Medical Center, New York City, NY, USA.
2 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Am J Hosp Palliat Care. 2019 Apr;36(4):333-338. doi: 10.1177/1049909118820846. Epub 2018 Dec 26.
: Many older adults are homebound due to chronic illness and suffer from significant symptoms, including pain. Home-based primary and palliative care (HBPC), which provides interdisciplinary medical and psychosocial care for this population, has been shown to significantly reduce symptom burden. However, little is known about how pain is managed in the homebound.
: This article describes pain management for chronically, ill homebound adults in a model, urban HBPC program.
DESIGN/MEASUREMENTS:: This was a prospective observational cohort study of newly enrolled HBPC patients, who completed a baseline Edmonton Symptom Assessment System (ESAS) survey during the initial HBPC visit (N = 86). Baseline pain burden was captured by ESAS and pain severity was categorized as none, mild, or moderate-severe. All pain-related assessments and treatments over a 6-month period were categorized by medication type and titration, referrals to outside providers, procedures, and equipment.
: At baseline, 55% of the study population had no pain, 18% had mild pain, and 27% had moderate-severe pain. For those with moderate-severe pain at baseline (n = 23), prescriptions for pharmacological treatments for pain, such as opiates and acetaminophen, increased during the study period from 48% to 57% and 52% to 91%, respectively. Nonpharmacological interventions, including referrals to outside providers such as physical therapy, procedures, and equipment for pain management, were also common and 67% of the study population received a service referral during the follow-up period.
: Pharmacological and nonpharmacological treatments are widely used in the setting of HBPC to treat the pain of homebound, older adults.
许多老年人因慢性病而居家不出，并遭受包括疼痛在内的严重症状的折磨。为这一人群提供跨学科医疗和心理社会护理的居家初级和姑息治疗（HBPC）已被证明能显著减轻症状负担。然而，对于居家患者的疼痛管理方式却知之甚少。
本文描述了在一个典型的城市HBPC项目中，对患有慢性病的居家老年人的疼痛管理。
设计/测量：这是一项对新登记的HBPC患者进行的前瞻性观察队列研究，这些患者在首次HBPC就诊时完成了基线埃德蒙顿症状评估系统（ESAS）调查（N = 86）。ESAS记录了基线疼痛负担，疼痛严重程度分为无、轻度或中度至重度。对6个月期间所有与疼痛相关的评估和治疗，按照药物类型和滴定、转介至外部医疗机构、操作和设备进行分类。
在基线时，55%的研究人群无疼痛，18%有轻度疼痛，27%有中度至重度疼痛。对于基线时有中度至重度疼痛的患者（n = 23），在研究期间，用于疼痛的药物治疗处方，如阿片类药物和对乙酰氨基酚，分别从48%增加到57%和从52%增加到91%。非药物干预，包括转介至外部医疗机构如物理治疗、用于疼痛管理的操作和设备，也很常见，67%的研究人群在随访期间接受了服务转介。
在HBPC环境中，药物和非药物治疗被广泛用于治疗居家老年人的疼痛。
