对慢性疼痛且阿片类药物相关伤害风险升高的住院患者的干预措施：一项试点随机对照试验。
Intervention for hospitalized people with chronic pain and elevated risk for opioid-related harm: A pilot randomized controlled trial.
作者信息
Weimer Melissa B, Buonora Michele J, Hajduk Alexandra M, Ackerman Adam L, Daggula Krishna R, Becker William C, Chaudhry Sarwat I, Fiellin David A
机构信息
Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Sections of Health Policy and Management, and Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA.
出版信息
J Hosp Med. 2025 Apr 24. doi: 10.1002/jhm.70066.
BACKGROUND
The management of analgesia in people hospitalized with chronic pain and elevated risk for opioid-related harm is challenging. While opioid stewardship programs could provide guidance, their feasibility in this population has not been examined.
OBJECTIVES
To develop a case identification tool and evaluate the feasibility of an electronic medical record (EMR)-delivered opioid stewardship and pain intervention among hospitalized people with chronic pain and elevated risk for opioid-related harm.
METHODS
After developing and evaluating the operating characteristics of a case identification tool to identify people with chronic pain and elevated risk for opioid-related harm, hospitalized adults with chronic pain and elevated risk for opioid-related harm were randomized to an EMR-delivered opioid stewardship and pain intervention versus usual care. Primary outcomes were feasibility-based. Exploratory outcomes were pain-related clinical outcomes.
RESULTS
The case identification tool had a sensitivity of 88.9% and a specificity of 95.7%. The trial recruited 52/97 (54%) of potential participants who completed 52/52 (100%) potential assessments and of whom 45/52 (87%) were retained in the study at 4 weeks, demonstrating feasibility. On average, both treatment arms received 56% of the recommended guideline-concordant care and there was no significant difference in opioid and pain-related care in the two groups.
CONCLUSION
It is both feasible to develop an EMR-based tool to prospectively identify hospitalized people with chronic pain and elevated risk for opioid-related harm as well as recruit these individuals to an EMR-delivered opioid stewardship and pain intervention. Additional strategies to support the provision of guideline-concordant care may be warranted.
背景
对因慢性疼痛住院且存在阿片类药物相关伤害高风险的患者进行镇痛管理具有挑战性。虽然阿片类药物管理计划可以提供指导，但尚未研究其在该人群中的可行性。
目的
开发一种病例识别工具，并评估在因慢性疼痛住院且存在阿片类药物相关伤害高风险的患者中，通过电子病历（EMR）实施阿片类药物管理和疼痛干预的可行性。
方法
在开发和评估用于识别慢性疼痛且存在阿片类药物相关伤害高风险患者的病例识别工具的操作特征后，将因慢性疼痛住院且存在阿片类药物相关伤害高风险的成年患者随机分为接受EMR实施的阿片类药物管理和疼痛干预组与常规护理组。主要结局基于可行性。探索性结局为与疼痛相关的临床结局。
结果
病例识别工具的敏感性为88.9%，特异性为95.7%。该试验招募了97名潜在参与者中的52名（54%），这些参与者完成了52次（100%）潜在评估，其中45名（87%）在4周时仍留在研究中，证明了可行性。平均而言，两个治疗组均接受了推荐的符合指南护理的56%，两组在阿片类药物和疼痛相关护理方面无显著差异。
结论
开发一种基于EMR的工具来前瞻性识别因慢性疼痛住院且存在阿片类药物相关伤害高风险的患者，并将这些个体纳入EMR实施的阿片类药物管理和疼痛干预是可行的。可能需要额外的策略来支持提供符合指南的护理。
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