CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma-Emergency-Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada.
Faculty of Nursing, Université Laval, Québec City, Quebec G1V 0A6, Canada.
Pain Med. 2023 Aug 1;24(8):933-940. doi: 10.1093/pm/pnad037.
Prolonged opioid use is common following traumatic injuries. Although preventive strategies have been recommended, the evidence supporting their use is low. The objectives of this study were to select interdisciplinary strategies to prevent long-term, detrimental opioid use in trauma patients for further evaluation and to identify implementation considerations.
A consensus study using the nominal group technique.
Four trauma systems in Canada.
Participants included expert clinicians and decision makers, and people with lived experience.
Participants had to discuss the relevance and implementation of 15 strategies and then rank them using a 7-point Likert scale. Implementation considerations were identified through a synthesis of discussions.
A total of 41 expert stakeholders formed the nominal groups. Overall, eight strategies were favored: 1) using multimodal approach for pain management, 2) professional follow-up in physical health, 3) assessment of risk factors for opioid misuse, 4) physical stimulation, 5) downward adjustment of opioids based on patient recovery, 6) educational intervention for patients, 7) training offered to professionals on how to prescribe opioids, and 8) optimizing communication between professionals working in different settings. Discussions with expert stakeholders revealed the rationale for the selected strategies and identified issues to consider when implementing them.
This stakeholder consensus study identified, for further scientific study, a set of interdisciplinary strategies to promote appropriate opioid use following traumatic injuries. These strategies could ultimately decrease the burden associated with long-term opioid use.
创伤后常出现长期阿片类药物使用。尽管已经推荐了预防策略，但支持其使用的证据有限。本研究的目的是选择跨学科策略，以进一步评估和确定实施考虑因素，防止创伤患者长期使用有害的阿片类药物。
使用名义小组技术的共识研究。
加拿大四个创伤系统。
参与者包括专家临床医生和决策者，以及有过亲身经历的人。
参与者必须讨论 15 种策略的相关性和实施情况，然后使用 7 点李克特量表对其进行排名。通过综合讨论确定实施注意事项。
共有 41 名专家利益相关者组成了名义小组。总体而言，有八项策略受到青睐：1）采用多模式方法进行疼痛管理，2）提供身体健康方面的专业随访，3）评估阿片类药物滥用风险因素，4）身体刺激，5）根据患者恢复情况下调阿片类药物剂量，6）对患者进行教育干预，7）对专业人员进行有关如何开处阿片类药物的培训，8）优化不同环境下专业人员之间的沟通。与专家利益相关者的讨论揭示了所选策略的基本原理，并确定了在实施这些策略时需要考虑的问题。
这项利益相关者共识研究确定了一组跨学科策略，以促进创伤后适当使用阿片类药物。这些策略最终可能会降低与长期使用阿片类药物相关的负担。
