NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol.
Population Health Sciences, Bristol Medical School, University of Bristol; South Gloucestershire Council, Bristol.
Br J Gen Pract. 2020 Jan 30;70(691):e120-e129. doi: 10.3399/bjgp19X706097. Print 2020 Feb.
Primary care opioid prescribing to treat chronic non-cancer pain (CNCP) has progressively increased despite a lack of evidence for long-term safety and effectiveness. Developing primary care interventions to reduce opioid dependence in patients with CNCP is a public health priority.
To report the acceptability of the South Gloucestershire pain and opioid review service for patients with CNCP, which aimed to help patients understand their relationship with prescribed opioids and support non-drug-based pain management strategies.
A mixed-methods evaluation was performed on the service, which was based in two GP practices in South Gloucestershire, England, and delivered by project workers.
Descriptive data were collected on delivered-within-service and community-based interventions. Twenty-five semi-structured interviews ( = 18 patients, = 7 service providers) explored experiences of the service.
The enrolment process, person-centred primary care-based delivery, and service content focused on psychological issues underlying CNCP were found to be acceptable to patients and service providers. Patients welcomed having time to discuss their pain, its management, and related psychological issues. Maintaining a long-term approach was desired as CNCP is a complex issue that takes time to address. GPs recommended that funding was needed to ensure they have dedicated time to support a similar service and to ensure that project workers received adequate clinical supervision.
This service model was acceptable and may be a useful means to manage patients with CNCP who develop opioid dependence after long-term use of opioids. A randomised controlled trial is needed to formally test the effectiveness of the service.
尽管缺乏长期安全性和有效性的证据，初级保健阿片类药物处方治疗慢性非癌症疼痛（CNCP）的情况仍在逐渐增加。制定减少 CNCP 患者阿片类药物依赖的初级保健干预措施是公共卫生的重点。
报告南格洛斯特郡疼痛和阿片类药物审查服务对 CNCP 患者的可接受性，该服务旨在帮助患者了解他们与处方阿片类药物的关系，并支持非药物性疼痛管理策略。
对该服务进行了混合方法评估，该服务位于英格兰南格洛斯特郡的两个全科医生实践中，由项目工作人员提供。
收集了服务内和社区干预措施的交付情况描述性数据。对 25 名半结构化访谈（=18 名患者，=7 名服务提供者）进行了探索性研究，以了解他们对该服务的体验。
患者和服务提供者都认为，该服务的招募流程、以患者为中心的初级保健服务提供方式以及针对 CNCP 潜在心理问题的服务内容是可以接受的。患者欢迎有时间讨论他们的疼痛、疼痛管理以及相关的心理问题。由于 CNCP 是一个复杂的问题，需要时间来解决，因此需要保持长期的治疗方法。全科医生建议需要提供资金，以确保他们有专门的时间来支持类似的服务，并确保项目工作人员获得足够的临床监督。
该服务模式是可以接受的，可能是管理长期使用阿片类药物后出现阿片类药物依赖的 CNCP 患者的一种有用方法。需要进行随机对照试验来正式检验该服务的有效性。
