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TANGO:制定消费者信息传单以支持低腰背痛和髋膝关节骨关节炎老年患者阿片类药物的 TAPERI NG。

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis.

机构信息

The University of Sydney, Sydney Musculoskeletal Health and Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, Sydney, NSW, 2065, Australia.

The University of Sydney, Sydney Musculoskeletal Health, Charles Perkins Centre, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Eora Country, Sydney, NSW, Australia.

出版信息

Drugs Aging. 2023 Apr;40(4):343-354. doi: 10.1007/s40266-023-01011-x. Epub 2023 Mar 27.


DOI:10.1007/s40266-023-01011-x
PMID:36972011
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10040925/
Abstract

INTRODUCTION: Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as their adverse effects outweigh their modest benefit. Deprescribing opioids is a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of the process of, or outcomes from, weaning medications, or a lack of ongoing support. Thus, involving patients, their carers, and healthcare professionals (HCPs) in the development of consumer materials that can educate and provide support for patients and HCPs over the deprescribing process is critical to ensure that the resources have high readability, usability, and acceptability to the population of interest. OBJECTIVE: This study aimed to (1) develop two educational consumer leaflets to support opioid tapering in older people with low back pain (LBP) and hip or knee osteoarthritis (HoKOA), and (2) evaluate the perceived usability, acceptability, and credibility of the consumer leaflets from the perspective of consumers and HCPs. DESIGN: This was an observational survey involving a consumer review panel and an HCP review panel. PARTICIPANTS: 30 consumers (and/or their carers) and 20 HCPs were included in the study. Consumers were people older than 65 years of age who were currently experiencing LBP or HoKOA, and with no HCP background. Carers were people who provided unpaid care, support, or assistance to an individual meeting the inclusion criteria for consumers. HCPs included physiotherapists (n = 9), pharmacists (n = 7), an orthopaedic surgeon (n = 1), a rheumatologist (n = 1), nurse practitioner (n = 1) and a general practitioner (n = 1), all with at least three years of clinical experience and who reported working closely with this target patient population within the last 12 months. METHODS: Prototypes of two educational consumer leaflets (a brochure and a personal plan) were developed by a team of LBP, OA, and geriatric pharmacotherapy researchers and clinicians. The leaflet prototypes were evaluated by two separate chronological review panels involving (1) consumers and/or their carers, and (2) HCPs. Data collection for both panels occurred via an online survey. Outcomes were the perceived usability, acceptability, and credibility of the consumer leaflets. Feedback received from the consumer panel was used to refine the leaflets, before circulating the leaflets for further review by the HCP panel. Additional feedback from the HCP review panel was then used to refine the final versions of the consumer leaflets. RESULTS: Both consumers and HCPs perceived the leaflets and personal plan to be usable, acceptable, and credible. Consumers rated the brochure against several categories, which scored between 53 and 97% positive responses. Similarly, the overall feedback provided by HCPs was 85-100% positive. The modified System Usability Scale scores obtained from HCPs was 55-95% positive, indicating excellent usability. Feedback for the personal plan from both HCPs and consumers was largely positive, with consumers providing the highest positive ratings (80-93%). While feedback for HCPs was also high, we did identify that prescribers were hesitant to provide the plan to patients frequently (no positive responses). CONCLUSIONS: This study led to the development of a leaflet and personal plan to support the reduction of opioid use in older people with LBP or HoKOA. The development of the consumer leaflets incorporated feedback provided by HCPs and consumers to maximise clinical effectiveness and future intervention implementation.

摘要

简介:全球范围内,尽管指南建议避免使用阿片类药物,因其不良反应超过了其适度的益处,但慢性肌肉骨骼疾病的阿片类药物处方率仍然很高。减少阿片类药物的使用是一个复杂的过程,可能会受到多种与处方者和患者相关的障碍的阻碍。这些障碍包括对药物减药过程或结果的恐惧,或缺乏持续的支持。因此,让患者、他们的照顾者和医疗保健专业人员(HCPs)参与制定消费者材料,以教育和支持患者和 HCPs 度过减药过程,对于确保资源具有高可读性、可用性和可接受性至关重要。 目的:本研究旨在(1)制定两份支持老年人腰痛(LBP)和髋或膝关节骨关节炎(HoKOA)患者阿片类药物逐渐减少的教育性消费者传单,以及(2)从消费者和 HCP 的角度评估消费者传单的感知可用性、可接受性和可信度。 设计:这是一项观察性调查,涉及消费者审查小组和 HCP 审查小组。 参与者:共有 30 名消费者(和/或他们的照顾者)和 20 名 HCP 参与了这项研究。消费者是年龄在 65 岁以上,目前正在经历 LBP 或 HoKOA,并且没有 HCP 背景的人。照顾者是为符合消费者纳入标准的个人提供无薪护理、支持或帮助的人。HCPs 包括物理治疗师(n=9)、药剂师(n=7)、骨科医生(n=1)、风湿病专家(n=1)、护士从业者(n=1)和全科医生(n=1),他们都有至少三年的临床经验,并报告在过去 12 个月内与这一目标患者群体密切合作。 方法:由 LBP、OA 和老年药物治疗学研究人员和临床医生组成的团队制定了两份教育性消费者传单(一本小册子和一份个人计划)的原型。传单原型由两个独立的按时间顺序排列的审查小组进行评估,其中包括(1)消费者和/或他们的照顾者,以及(2)HCPs。两个小组都通过在线调查收集数据。结果是消费者传单的感知可用性、可接受性和可信度。从消费者小组收到的反馈用于改进传单,然后在 HCP 小组进一步审查之前分发传单。然后,HCP 审查小组的额外反馈用于改进消费者传单的最终版本。 结果:消费者和 HCP 都认为传单和个人计划是可用的、可接受的和可信的。消费者对小册子进行了多项评估,评分在 53%到 97%之间为正面回应。同样,HCP 提供的整体反馈也是 85-100%为正面。HCP 获得的改良系统可用性量表评分在 55-95%之间为正面,表明可用性极好。来自 HCPs 和消费者的个人计划的反馈大多为正面,消费者的评分最高(80-93%)。虽然 HCP 的反馈也很高,但我们确实发现,医生不愿意经常向患者提供该计划(没有正面回应)。 结论:本研究开发了一份支持 LBP 或 HoKOA 老年患者减少阿片类药物使用的传单和个人计划。消费者传单的开发纳入了 HCPs 和消费者提供的反馈,以最大限度地提高临床效果和未来干预措施的实施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6421/10113318/43e5f8be5d83/40266_2023_1011_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6421/10113318/43e5f8be5d83/40266_2023_1011_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6421/10113318/43e5f8be5d83/40266_2023_1011_Fig1_HTML.jpg

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引用本文的文献

[1]
An evidence-based digital prescription opioid safety toolkit for national dissemination: co-design and user testing.

Front Digit Health. 2025-7-11

[2]
Accessible Patient Education Materials for Low Back Pain Rarely Meet People's Information Needs: A Scoping Review.

Musculoskeletal Care. 2025-6

[3]
Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain.

JAMA Netw Open. 2024-3-4

本文引用的文献

[1]
Opioids and Falls Risk in Older Adults: A Narrative Review.

Drugs Aging. 2022-3

[2]
Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: a systematic review with qualitative evidence synthesis using the Theoretical Domains Framework.

BMJ Qual Saf. 2022-5

[3]
"The lesser of two evils": a framework analysis of consumers' perspectives on opioid deprescribing and the development of opioid deprescribing guidelines.

Pain. 2021-11-1

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What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies.

J Intern Med. 2020-2-25

[5]
Development of consumer information leaflets for deprescribing in older hospital inpatients: a mixed-methods study.

BMJ Open. 2019-12-11

[6]
Frameworks for supporting patient and public involvement in research: Systematic review and co-design pilot.

Health Expect. 2019-8

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General practitioners and management of chronic noncancer pain: a cross-sectional survey of influences on opioid deprescribing.

J Pain Res. 2019-1-22

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Ther Adv Drug Saf. 2018-9-12

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Identification of behaviour change techniques in deprescribing interventions: a systematic review and meta-analysis.

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