产科医生对减少产后阿片类药物使用的指南和筛查工具的信念和知识。
Obstetric Physicians' Beliefs and Knowledge on Guidelines and Screening Tools to Reduce Opioid Use After Childbirth.
机构信息
Department of Kinesiology, College of Health and Human Development, and the Department of Obstetrics and Gynecology, Penn State College of Medicine, the Exercise Psychology Laboratory, Department of Kinesiology, the Pennsylvania State University, University Park, the Division of Maternal-Fetal Medicine, Women's Health Service Line, Geisinger, Danville, the Department of Obstetrics and Gynecology, Penn State Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, the Department of Family and Community Medicine, Penn State College of Medicine, University Park, the Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, the Department of Health and Human Development, Pennsylvania State University, University Park, and the Department of Epidemiology and Health Services Research, Geisinger, Danville, Pennsylvania.
出版信息
Obstet Gynecol. 2021 Feb 1;137(2):325-333. doi: 10.1097/AOG.0000000000004232.
OBJECTIVE
To examine obstetric physicians' beliefs about using professional or regulatory guidelines, opioid risk-screening tools, and preferences for recommending nonanalgesic therapies for postpartum pain management.
METHODS
A qualitative study design was used to conduct semi-structured interviews with obstetric and maternal-fetal medicine physicians (N=38) from two large academic health care institutions in central Pennsylvania. An interview guide was used to direct the discussion about each physicians' beliefs in response to questions about pain management after childbirth.
RESULTS
Three trends in the data emerged from physicians' responses: 1) 71% of physicians relied on their clinical insight rather than professional or regulatory guidelines to inform decisions about pain management after childbirth; 2) although many reported that a standard opioid patient screening tool would be useful to inform clinical decisions about pain management, nearly all (92%) physician respondents reported not currently using one; and 3) 63% thought that nonpharmacologic pain management therapies should be used whenever possible to manage pain after childbirth. Key physician barriers (eg, lack time and evidence, being unaware of how to implement) and patient barriers (eg, take away from other responsibilities, no time or patience) to implementation were also identified.
CONCLUSION
These findings suggest that obstetric physicians' individual beliefs and clinical insight play a key role in pain management decisions for women after childbirth. Practical and scalable strategies are needed to: 1) encourage obstetric physicians to use professional or regulatory guidelines and standard opioid risk-screening tools to inform clinical decisions about pain management after childbirth, and 2) educate physicians and patients about nonopioid and nonpharmacologic pain management options to reduce exposure to prescription opioids after childbirth.
目的
探讨妇产科医师在使用专业或监管指南、阿片类药物风险筛查工具以及推荐非镇痛疗法治疗产后疼痛管理方面的信念。
方法
采用定性研究设计，对宾夕法尼亚州中部两家大型学术医疗保健机构的妇产科和母胎医学医师（N=38）进行半结构化访谈。使用访谈指南指导讨论每位医师对产后疼痛管理的信念，回应有关疼痛管理的问题。
结果
医师回答中出现了三种趋势：1）71%的医师依赖于他们的临床洞察力而不是专业或监管指南来为产后疼痛管理决策提供信息；2）尽管许多医师报告说标准的阿片类药物患者筛查工具将有助于为疼痛管理决策提供信息，但几乎所有（92%）医师受访者表示目前未使用该工具；3）63%的医师认为非药物性疼痛管理疗法应尽可能用于管理产后疼痛。还确定了实施的主要医师障碍（例如，缺乏时间和证据、不知道如何实施）和患者障碍（例如，会占用其他职责的时间、没有时间或耐心）。
结论
这些发现表明，妇产科医师的个人信念和临床洞察力在产后女性的疼痛管理决策中起着关键作用。需要制定切实可行和可扩展的策略：1）鼓励妇产科医师使用专业或监管指南和标准阿片类药物风险筛查工具来为产后疼痛管理决策提供信息；2）教育医师和患者了解非阿片类和非药物性疼痛管理选择，以减少产后处方类阿片类药物的暴露。
Zotero 插件