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目前促进安全和适当疼痛管理的干预措施。

Current interventions to promote safe and appropriate pain management.

机构信息

Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA.

Department of Anesthesiology, Weill Cornell Medicine, New York, NY.

出版信息

Am J Health Syst Pharm. 2019 May 17;76(11):829-834. doi: 10.1093/ajhp/zxz063.

Abstract

PURPOSE

Describe patient-, clinician-, system-, and community-level interventions for pain management developed and employed by 9 healthcare systems across the United States and report on lessons learned from the implementation of these interventions.

SUMMARY

The high cost associated with pain coupled with the frequent use of opioid analgesics as primary treatment options has made novel pain management strategies a necessity. Interventions that target multiple levels within healthcare are needed to help combat the opioid epidemic and improve strategies to manage chronic pain. Patient-level interventions implemented ranged from traditional paper-based educational tools to videos, digital applications, and peer networks. Clinician-level interventions focused on providing education, ensuring proper follow-up care, and establishing multidisciplinary teams that included prescribers, pharmacists, nurses, and other healthcare professionals. System- and community-level interventions included metric tracking and analytics, electronic health record tools, lockbox distribution for safe storage, medication return bins for removal of opioids, risk assessment tool utilization, and improved access to reversal agents.

CONCLUSION

Strategies to better manage pain can be implemented within health systems at multiple levels and on many fronts; however, these changes are most effective when accepted and widely used by the population for which they are targeted.

摘要

目的

描述美国 9 个医疗保健系统开发和采用的患者、临床医生、系统和社区层面的疼痛管理干预措施,并报告实施这些干预措施的经验教训。

总结

疼痛相关成本高,阿片类镇痛药经常被用作主要治疗选择,这使得新型疼痛管理策略成为必要。需要针对医疗保健的多个层面实施干预措施,以帮助对抗阿片类药物泛滥,并改进管理慢性疼痛的策略。已实施的患者层面干预措施范围从传统的纸质教育工具到视频、数字应用程序和同行网络。临床医生层面的干预措施侧重于提供教育、确保适当的随访护理,并建立包括处方者、药剂师、护士和其他医疗保健专业人员在内的多学科团队。系统和社区层面的干预措施包括指标跟踪和分析、电子健康记录工具、安全储存用的锁箱分发、用于去除阿片类药物的药物回收箱、风险评估工具的使用以及改善获取逆转剂的机会。

结论

可以在医疗系统的多个层面和多个方面实施更好地管理疼痛的策略;但是,当这些策略被目标人群接受并广泛使用时,这些改变才最有效。

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