Hoffmann Chelsey, McDonald Trina, Gladis Becky, Schatman Michael E, Pittelkow Thomas P
Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA.
J Pain Res. 2025 May 26;18:2699-2706. doi: 10.2147/JPR.S521458. eCollection 2025.
Intrathecal drug delivery systems (IDDS) are effective tools for the management of chronic non-cancer pain, cancer-associated pain, and spasticity. Given the overall risks of opioid medications, it is imperative that IDDS opioid-infusion patients receive education regarding the risks versus benefits of their intrathecal opioid medications and that controlled substance agreements (CSAs) are utilized to both educate patients and hold them accountable for keeping IDDS programming visits, refill appointments, or other IDDS maintenance appointments.
A retrospective electronic medical record (EMR) review study was conducted at an interventional pain management practice, quantifying the number of non-cancer chronic pain IDDS opioid therapy patients with signed CSAs. An educational intervention was conducted to increase staff awareness regarding compliance with CSAs and the location of proper CSA documentation within the EMR. Follow-up EMR review and provider knowledge assessment surveys were deployed to assess the success of the intervention.
Staff knowledge of CSAs increased from 14.3% (3/21) to 45.5% (10/22) following CSA education while their ability to locate CSAs within the EMR also increased from 38.1% (8/21) to 40.9% (9/22). Post-education intervention, rates of CSA documentation improved from 4.5% to 74.5%. Lastly, there was a 39.5% reduction in rescheduled IDDS appointments within the patient population studied.
The results of this study suggest potentially profound impacts that a simple education intervention can have on staff knowledge and compliance with CSA documentation for patients receiving IDDS opioid therapy for chronic non-cancer pain. Furthermore, implementation of CSAs for this patient population may be associated with a decrease in the number of missed, no-show, or rescheduled IDDS maintenance appointments, which have important patient safety implications. Further research is warranted to investigate the impact of CSA compliance on adverse patient outcomes and the potential cost-savings practices with required CSAs.
鞘内药物输送系统（IDDS）是管理慢性非癌性疼痛、癌症相关疼痛和痉挛的有效工具。鉴于阿片类药物的总体风险，接受鞘内阿片类药物输注的患者必须接受有关鞘内阿片类药物风险与益处的教育，并且必须利用受控物质协议（CSA）来教育患者，并要求他们对进行IDDS程序访视、续方预约或其他IDDS维护预约负责。
在一家介入性疼痛管理机构进行了一项回顾性电子病历（EMR）审查研究，对签署了CSA的非癌性慢性疼痛IDDS阿片类药物治疗患者的数量进行量化。开展了一项教育干预措施，以提高工作人员对CSA合规性以及EMR中适当CSA文件位置的认识。部署了后续EMR审查和提供者知识评估调查，以评估干预措施的成效。
CSA教育后，工作人员对CSA的知晓率从14.3%（3/21）提高到45.5%（10/22），同时他们在EMR中查找CSA的能力也从38.1%（8/21）提高到40.9%（9/22）。教育干预措施实施后，CSA文件记录率从4.5%提高到74.5%。最后，在所研究的患者群体中，IDDS预约重新安排的比例降低了39.5%。
本研究结果表明，一项简单的教育干预措施可能会对接受慢性非癌性疼痛IDDS阿片类药物治疗患者的工作人员知识以及CSA文件合规性产生潜在的深远影响。此外，针对该患者群体实施CSA可能与错过、未到或重新安排的IDDS维护预约数量减少有关，这对患者安全具有重要意义。有必要进一步研究，以调查CSA合规性对不良患者结局的影响以及所需CSA的潜在成本节约做法。
