Division of Psychiatry, University College London, London, UK.
Marie Curie Palliative Care Research Department, University College London, London, UK.
Int J Geriatr Psychiatry. 2021 Sep;36(9):1354-1361. doi: 10.1002/gps.5526. Epub 2021 Mar 14.
To (1) describe the prescription and administration of regular and 'as required' (pro re nata [PRN]) analgesics in English care homes, (2) investigate individual and care home factors associated with analgesic use.
We collected data (2014-2016) at 0-, 4-, and 12-months nested in a longitudinal cohort study of 86 English care homes about residents with diagnosed or probable dementia. We describe analgesics prescribed as regular or PRN medication, by class, and PRN administration. We explored individual differences (sociodemographic; dementia severity [Clinical Dementia Rating]), and care home differences (type; ownership; number of beds; dementia-registered/specialist; Care Quality Commission rating) in prescription and administration using multilevel regression models.
Data were available for 1483 residents. At baseline, 967 residents (67.9%) were prescribed analgesics: 426 residents (28.7%) prescribed regular analgesics and 670 (45.2%) prescribed PRN. Paracetamol was the most prescribed analgesic (56.7%), with PRN prescriptions more common than regular (39.7% vs. 16.6%). Across all study visits, 344 residents (mean = 41.9%) with a PRN prescription did not receive any analgesic in the 2 weeks prior to data collection. Male residents and those with severe dementia received fewer analgesics. Care homes differences in PRN administration were not explained by the modelled variables.
Pain management in English care homes largely relies on PRN paracetamol that is frequently prescribed but infrequently administered. Care homes differ in how often they administer PRN analgesics. Some care home residents particularly those with more severe dementia are likely to have untreated pain.
（1）描述英国养老院常规和“按需”（pro re nata [PRN]）镇痛药的处方和管理情况，（2）调查与镇痛药物使用相关的个体和养老院因素。
我们在一项针对有诊断或可能患有痴呆症的 86 家英国养老院居民的纵向队列研究中，于 0、4 和 12 个月时嵌套收集数据。我们按类别描述了常规或 PRN 药物处方的镇痛药，并描述了 PRN 给药情况。我们使用多水平回归模型探索了个体差异（社会人口统计学；痴呆严重程度[临床痴呆评定]）和养老院差异（类型；所有权；床位数量；登记/专业痴呆症；护理质量委员会评级）对处方和管理的影响。
共纳入 1483 名居民的数据。基线时，967 名居民（67.9%）开具了镇痛药：426 名居民（28.7%）开具了常规镇痛药，670 名居民（45.2%）开具了 PRN 镇痛药。扑热息痛是最常开的镇痛药（56.7%），PRN 处方比常规处方更常见（39.7% vs. 16.6%）。在所有研究访问期间，344 名有 PRN 处方的居民（平均 41.9%）在数据收集前的 2 周内未接受任何镇痛药。男性居民和痴呆症严重的居民接受的镇痛药较少。PRN 给药方面的养老院差异不能用模型变量来解释。
英国养老院的疼痛管理主要依赖于 PRN 扑热息痛，尽管该药经常开处方，但很少使用。养老院在 PRN 镇痛药的给药频率上存在差异。一些养老院的居民，特别是那些痴呆症更严重的居民，可能存在未得到治疗的疼痛。
