School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, B15 2TT, Birmingham, England, UK.
Eur J Clin Pharmacol. 2021 Apr;77(4):467-490. doi: 10.1007/s00228-020-03026-4. Epub 2020 Oct 30.
Sub-optimal opioid prescribing and use is viewed as a major contributor to the growing opioid crisis. This study aims to systematically review the nature, process and outcomes of interventions to optimize prescribed medicines and reduce their misuse in chronic non-malignant pain (CNMP) with a particular focus on minimizing misuse of opiates.
A systematic review of literature was undertaken. Search of literature using Medline, EMBASE and CINAHL databases from 2000 onwards was conducted. Screening and selection, data extraction and risk of bias assessments were undertaken by two independent reviewers. Narrative synthesis of the data was conducted.
A total of 21 studies were included in the review, of which three were RCTs. Interventions included clinical (e.g. urine drug testing, opioid treatment contract, pill count), behavioural (e.g. electrical diaries about craving), cognitive behavioural treatment and/or educational interventions for patients and healthcare providers delivered as a single or as a multi-component intervention. Medication optimization outcomes included aspects of misuse, abuse, aberrant drug behaviour, adherence and non-adherence. Although all evaluations showed improvement in medication optimization outcomes, multi-component interventions were more likely to consider and to have shown improvement in clinical outcomes such as pain intensity, quality of life, psychological states and functional improvement compared to single-component interventions.
A well-structured CNMP management programme to promote medicines optimization should include multi-component interventions delivered by a multidisciplinary team of healthcare professionals and target both healthcare professionals and patients. There was heterogeneity in definitions applied and interventions evaluated. There is a need for the development of clear and consistent terminology and measurement criteria to facilitate better comparisons of research evidence.
阿片类药物处方和使用不规范被认为是阿片类药物危机日益严重的主要原因之一。本研究旨在系统地回顾优化处方药物和减少慢性非恶性疼痛（CNMP）中药物滥用的干预措施的性质、过程和结果，特别关注减少阿片类药物的滥用。
进行了文献系统评价。从 2000 年开始，使用 Medline、EMBASE 和 CINAHL 数据库进行文献搜索。两名独立评审员进行了筛选和选择、数据提取和偏倚风险评估。对数据进行了叙述性综合。
共纳入 21 项研究，其中 3 项为 RCT。干预措施包括临床干预（如尿液药物检测、阿片类药物治疗合同、药丸计数）、行为干预（如关于渴望的电子日记）、认知行为治疗和/或针对患者和医疗保健提供者的教育干预措施，作为单一或多组分干预措施提供。药物优化结果包括药物滥用、滥用、异常药物行为、依从性和不依从性等方面。尽管所有评估都显示药物优化结果有所改善，但与单一成分干预相比，多成分干预更有可能考虑并显示出改善临床结果，如疼痛强度、生活质量、心理状态和功能改善。
促进药物优化的完善的 CNMP 管理方案应包括由多学科医疗保健专业人员团队提供的多组分干预措施，并针对医疗保健专业人员和患者。所应用的定义和评估的干预措施存在异质性。需要制定明确和一致的术语和测量标准，以促进更好地比较研究证据。
