Niemann Anja, Schrader Nils Frederik, Speckemeier Christian, Abels Carina, Blase Nikola, Weitzel Milena, Neumann Anja, Riederer Cordula, Nadstawek Joachim, Straßmeir Wolfgang, Wasem Jürgen, Neusser Silke
Institute for Healthcare Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
DAK-Gesundheit, Nagelsweg 27, 20097, Hamburg, Germany.
BMC Prim Care. 2025 Jun 21;26(1):200. doi: 10.1186/s12875-025-02881-3.
Managing patients with chronic non-cancer pain (CNCP) in outpatient healthcare is challenging. Long-term opioid therapy is an option for treatment responders with guideline recommended indications. However, opioid use poses risks of severe side effects, including misuse, and therefore needs to be integrated into a high-quality healthcare process. This analysis evaluates the association between healthcare quality according to the evidence-based Chronic Care Model (CCM) in the treatment process of patients receiving long-term opioid therapy for chronic back and/or arthrosis pain, and patient-related or healthcare related variables.
A cross-sectional patient survey was sent to a random sample of 3,037 individuals with long-term opioid therapy and chronic back and/or arthrosis pain insured by a large nationwide German statutory health insurance. Healthcare quality according to the CCM was assessed by the Patient Assessment of Chronic Illness Care (PACIC-5A) questionnaire. Internal reliability of the assessment instrument was determined using Cronbach's α. Descriptive analysis of the outcome scales were conducted, alongside subgroup analyses considering patient characteristics, patient's health situation, and pain treatment aspects. Testing for statistical significance was performed by Mann-Whitney U test and Kruskal-Wallis test. Effect sizes, namely Eta and Spearman's Rank correlation coefficient, were calculated.
The analysis included 661 individuals. Participants were predominantly female (76%) with an average age of 69 years (SD 12.5). PACIC-5A score ratings across all (sub)scales were low, with a summary score rating of 2.4 (on a scale ranging from 1 (worst) to 5 (best)). Positive correlations with treatment quality were observed in the subgroup analysis concerning guideline-compliant pain treatment aspects such as setting therapy goals or a comprehensive treatment concept. Patient characteristics showed little to no correlations, except for a positive correlation between higher PACIC-5A rating and both lower age and higher education. Patient's health situation presented a mixed picture, with no clear correlation between pain intensity/impairment, and PACIC-5A scores.
The provision of healthcare for patients with long-term opioid therapy for CNCP seems to be inadequate according to the CCM. Guideline-recommended pain treatment aspects exhibited a positive correlation with healthcare quality according to CCM. Enhancing the implementation of the CCM in the outpatient healthcare process may improve healthcare quality.
German Clinical Trials Register, DRKS00024854. Registered 04/28/2021.
在门诊医疗中管理慢性非癌性疼痛（CNCP）患者具有挑战性。长期阿片类药物治疗是有指南推荐适应症的治疗反应者的一种选择。然而，使用阿片类药物存在包括滥用在内的严重副作用风险，因此需要将其纳入高质量的医疗过程。本分析评估了在接受长期阿片类药物治疗慢性背痛和/或关节病疼痛的患者治疗过程中，基于循证慢性照护模型（CCM）的医疗质量与患者相关或医疗相关变量之间的关联。
向3037名接受长期阿片类药物治疗且患有慢性背痛和/或关节病疼痛的个体随机样本发送了横断面患者调查问卷，这些个体由德国一家大型全国性法定健康保险承保。根据CCM的医疗质量通过慢性病照护患者评估（PACIC - 5A）问卷进行评估。使用克朗巴哈α系数确定评估工具的内部信度。对结果量表进行描述性分析，并进行考虑患者特征、患者健康状况和疼痛治疗方面的亚组分析。通过曼 - 惠特尼U检验和克鲁斯卡尔 - 沃利斯检验进行统计学显著性检验。计算效应量，即埃塔系数和斯皮尔曼等级相关系数。
分析纳入了661名个体。参与者主要为女性（占76%），平均年龄69岁（标准差12.5）。所有（亚）量表的PACIC - 5A评分都很低，总评分2.4（范围从1（最差）到5（最佳））。在关于符合指南的疼痛治疗方面（如设定治疗目标或全面治疗概念）的亚组分析中，观察到与治疗质量呈正相关。患者特征几乎没有相关性，除了较高的PACIC - 5A评分与较低年龄和较高教育程度之间呈正相关。患者的健康状况呈现出复杂的情况，疼痛强度/损伤与PACIC - 5A评分之间没有明显相关性。
根据CCM，为接受长期阿片类药物治疗CNCP的患者提供的医疗服务似乎不足。根据CCM，指南推荐的疼痛治疗方面与医疗质量呈正相关。在门诊医疗过程中加强CCM的实施可能会提高医疗质量。
德国临床试验注册中心，DRKS00024854。2021年4月28日注册。
