Hooten W Michael, Dvorkin Jodie, Warner Nafisseh S, Pearson Amy Cs, Murad M Hassan, Warner David O
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Institute for Clinical Systems Improvement , Minneapolis, MN, USA.
J Pain Res. 2019 Jul 24;12:2261-2289. doi: 10.2147/JPR.S202376. eCollection 2019.
The primary objective of this systematic review was to identify the characteristics of physicians who prescribe opioids to adults with chronic pain. This review was limited to studies examining fully-trained physicians, as relevant characteristics of resident physicians and non-physician clinicians may differ. A comprehensive search of databases from January 1, 1980 to December 5, 2017 was conducted. Eligible study designs included (1) randomized trials; (2) nonrandomized prospective and retrospective studies; and (3) cross-sectional observational studies. The risk of bias in the included studies was assessed using an adapted version of the Newcastle-Ottawa Scale for cross-sectional studies. A total of 2508 records were screened and 22 studies met inclusion criteria. The majority of studies were cross-sectional (n=20) and the total number of participants was 8433. The risk of bias was high overall. The majority of physicians were confident managing and prescribing opioids for chronic pain but had high levels of dissatisfaction. Physicians reported high awareness of the potential for opioid misuse and were concerned about inadequate prior training in pain management. The majority of physicians were less likely to prescribe for patients with a history of substance abuse and reported major concerns about regulatory scrutiny. This systematic review provides the foundation for the development of prospective studies aimed at further elucidating the constellation of mechanisms that influence physicians who manage pain and prescribe opioids.
本系统评价的主要目的是确定为慢性疼痛的成年患者开具阿片类药物的医生的特征。由于住院医师和非医师临床医生的相关特征可能不同，本评价仅限于对经过充分培训的医生进行的研究。对1980年1月1日至2017年12月5日的数据库进行了全面检索。符合条件的研究设计包括：（1）随机试验；（2）非随机前瞻性和回顾性研究；以及（3）横断面观察性研究。使用适用于横断面研究的纽卡斯尔-渥太华量表的改编版评估纳入研究的偏倚风险。共筛选了2508条记录，22项研究符合纳入标准。大多数研究为横断面研究（n = 20），参与者总数为8433人。总体偏倚风险较高。大多数医生对管理和开具慢性疼痛阿片类药物有信心，但满意度较高。医生报告对阿片类药物滥用可能性的认识较高，并担心疼痛管理方面的前期培训不足。大多数医生不太可能为有药物滥用史的患者开处方，并报告对监管审查存在重大担忧。本系统评价为开展前瞻性研究奠定了基础，旨在进一步阐明影响管理疼痛和开具阿片类药物的医生的一系列机制。
