University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Avera Sacred Heart Hospital, Yankton, South Dakota.
S D Med. 2022 Jan;75(1):26-31.
Patients who suffer chronic pain may seek the emergency department for opioids. There is no consensus on what constitutes an ED super-utilizer, so our definition is anyone who presented to the ED more than once for the same painful complaint. We sought to assess the effect of opioid guideline education for providers on super-utilizer visits for pain.
We performed a retrospective review of visits for chief complaints of pain one year before (phase one) and one year after (phase two) educating ED providers. The educational intervention consisted of a 20-minute explanation of the American Academy of Emergency Medicine's Model ED Pain Treatment Guidelines. McNemar's test was applied to the resultant data.
Phase one identified 218 super-utilizers accounting for 660 ED visits. Phase two identified 190 super- utilizers accounting for 604 ED visits. Both groups were stratified into those using the ED more than once, more than twice, and more than three times. There was a statistically significant difference in patients visiting the ED more than once (p=0.01) and more than three times (p=0.027), but not for those visiting more than twice (p=0.18). There was no statistically significant difference in total patient ED visits in any subgroup.
The total number of super-utilizers significantly decreased after the educational intervention. This educational intervention required minimal monetary and time investment. Further research is needed to determine if the educational intervention resulted in decreased opioid prescriptions and decreased number of people utilizing these drugs for non-medical purposes.
患有慢性疼痛的患者可能会到急诊科寻求阿片类药物。目前还没有关于什么是急诊科超级使用者的共识，因此我们的定义是任何因同一疼痛投诉到急诊科就诊超过一次的人。我们试图评估向提供者提供阿片类药物指南教育对疼痛超级使用者就诊的影响。
我们对一年前（第一阶段）和一年后（第二阶段）教育急诊科医生的主要疼痛投诉就诊进行了回顾性审查。教育干预包括对美国急诊医学学院的急诊疼痛治疗指南模型进行 20 分钟的解释。对所得数据应用 McNemar 检验。
第一阶段确定了 218 名超级使用者，占 660 次急诊科就诊；第二阶段确定了 190 名超级使用者，占 604 次急诊科就诊。两组均分为在急诊科就诊超过一次、两次和三次以上的患者。在就诊超过一次（p=0.01）和三次以上（p=0.027）的患者中存在统计学差异，但在就诊两次以上的患者中无统计学差异（p=0.18）。在任何亚组中，就诊的总患者人数均无统计学差异。
在教育干预后，超级使用者的总数显著减少。这种教育干预需要的资金和时间投入最小。需要进一步研究以确定教育干预是否导致阿片类药物处方减少和使用这些药物进行非医疗目的的人数减少。
