教育初级医生和药剂师以减少外科患者出院时开具的阿片类药物处方：一项集群随机对照试验。

Educating junior doctors and pharmacists to reduce discharge prescribing of opioids for surgical patients: a cluster randomised controlled trial.

机构信息

Alfred Health, Melbourne, VIC.

Centre for Medicine Use and Safety, Monash University, Melbourne, VIC.

出版信息

Med J Aust. 2020 Nov;213(9):417-423. doi: 10.5694/mja2.50812. Epub 2020 Oct 10.

DOI:10.5694/mja2.50812

PMID:33037644

Abstract

OBJECTIVES

To evaluate whether educating junior doctors and hospital pharmacists about analgesic prescribing improved discharge prescribing of opioids for opioid-naïve patients after surgical admissions.

DESIGN

Cluster randomised controlled trial, undertaken during the first half of 2019.

SETTING

The Alfred Hospital, a major Melbourne teaching hospital with 13 surgical units.

PARTICIPANTS

Opioid-naïve patients discharged from surgical units after a stay of at least 24 hours.

INTERVENTION

Surgical units were randomised to the intervention or control arms. Interns, residents, and clinical pharmacists assigned to intervention arm units attended education sessions, presented by the hospital analgesic stewardship pharmacist, about appropriate analgesic prescribing for patients in hospital surgical units.

MAIN OUTCOME MEASURES

The patients prescribed slow release opioids on discharge from hospital during the baseline (1 February - 30 April 2018) and post-intervention periods (17 February - 30 April 2019).

RESULTS

During the baseline period, 1369 intervention unit and 1014 control unit admissions were included in our analysis; during the evaluation period, 973 intervention unit and 706 control unit episodes were included. After adjusting for age, length of stay, pain score, acute pain service involvement, and use of immediate release opioids prior to admission, patients in the intervention group were prescribed slow release opioids at discharge less frequently than patients in the control group (adjusted odds ratio [aOR], 0.52; 95% CI, 0.35-0.77) and were more frequently discharged without any prescribed opioids following the intervention (aOR, 1.69; 95% CI, 1.24-2.30). Providing de-escalation plans was more frequent for intervention than control group patients prescribed slow release opioids on discharge post-intervention (OR, 2.36; 95% CI, 1.25-4.45).

CONCLUSIONS

Specific education for clinicians and pharmacists about appropriate analgesic prescribing for surgical patients is effective in reducing prescribing of opioids at discharge.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12618000876291 (prospective).

摘要

目的

评估对初级医生和医院药剂师进行有关阿片类药物处方教育是否能改善接受手术治疗的阿片类药物初治患者出院时的阿片类药物处方开具情况。

设计

在 2019 年上半年进行的整群随机对照试验。

地点

阿尔弗雷德医院，这是一家位于墨尔本的主要教学医院，拥有 13 个外科病房。

参与者

在外科病房住院至少 24 小时后出院的阿片类药物初治患者。

干预措施

外科病房被随机分配到干预组或对照组。参与干预组的实习医生、住院医生和临床药剂师参加了由医院阿片类药物管理药剂师授课的关于在医院外科病房为患者开具合适的镇痛处方的教育课程。

主要结局测量指标

在基线期（2018 年 2 月 1 日至 4 月 30 日）和干预后（2019 年 2 月 17 日至 4 月 30 日）出院时为患者开具缓释阿片类药物的情况。

结果

在基线期，1369 例干预病房和 1014 例对照病房的入院患者纳入了我们的分析；在评估期，973 例干预病房和 706 例对照病房的出院患者纳入了分析。在调整年龄、住院时间、疼痛评分、急性疼痛服务的参与情况以及入院前使用即时释放阿片类药物后，与对照组相比，干预组的患者出院时开具缓释阿片类药物的频率较低（调整后的比值比[aOR]，0.52；95%置信区间[CI]，0.35-0.77），并且在干预后更频繁地出院时未开具任何阿片类药物（aOR，1.69；95% CI，1.24-2.30）。与对照组相比，干预组开具缓释阿片类药物的患者出院时开具减药计划的频率更高（OR，2.36；95% CI，1.25-4.45）。