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患者与医护人员对术后疼痛管理的认知:影响阿片类药物持续使用的关键因素

Perceptions of patients and health care professionals on postoperative pain management: Key factors influencing persistent opioid use.

作者信息

Bansal Neetu, Hawkes Rhiannon E, Chen Li-Chia, Ashcroft Darren M, Armitage Christopher J

机构信息

Centre for Pharmacoepidemiology and Drug Safety, Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.

Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK.

出版信息

Br J Health Psychol. 2025 Sep;30(3):e70021. doi: 10.1111/bjhp.70021.

Abstract

OBJECTIVE

This study applied the Theoretical Domains Framework (TDF) to explore the barriers and enablers to optimizing post-operative pain management and supporting safe opioid use from the perspectives of both patients and health care professionals, applying the Theoretical Domains Framework (TDF).

DESIGN

Experience-based co-design (EBCD) qualitative study.

METHODS

In the initial phase of the EBCD approach, focus groups were conducted comprising 20 participants, including 8 patients and 12 health care professionals involved in post-operative care. The data were systematically analysed using framework analysis and mapped to the TDF. Intervention functions and behaviour change techniques (BCTs) targeting each TDF domain were identified.

RESULTS

Analysis revealed significant barriers faced by patients, including a lack of continuity in care, inadequate preoperative preparation, and insufficient guidance on opioid tapering. Health care professionals reported barriers associated with deficiencies in knowledge, skills, and environmental resources, particularly workforce constraints and ineffective communication across care settings. Notable enablers included pharmacist-led medication reviews and the adoption of digital technologies to enhance education and support tapering.

CONCLUSIONS

This study identifies critical barriers and facilitators that influence postoperative pain management and opioid use. Targeted interventions are imperative to optimize these outcomes. Key recommendations include implementing pharmacist-led medication reviews, integrating digital tapering support tools and enhancing preoperative educational efforts. Furthermore, strengthening communication pathways and addressing workforce challenges through dedicated training and resource allocation are essential. Future research should assess the efficacy of these tailored interventions across diverse clinical contexts to improve patient outcomes and refine prescribing practices.

摘要

目的

本研究应用理论领域框架(TDF),从患者和医护人员的角度探讨优化术后疼痛管理及支持安全使用阿片类药物的障碍和促进因素。

设计

基于经验的协同设计(EBCD)定性研究。

方法

在EBCD方法的初始阶段,开展了焦点小组讨论,共有20名参与者,包括8名患者和12名参与术后护理的医护人员。使用框架分析法对数据进行系统分析,并映射到TDF。确定了针对每个TDF领域的干预功能和行为改变技术(BCT)。

结果

分析发现患者面临的重大障碍,包括护理缺乏连续性、术前准备不足以及阿片类药物减量指导不足。医护人员报告了与知识、技能和环境资源不足相关的障碍,特别是劳动力限制以及不同护理环境之间沟通不畅。值得注意的促进因素包括由药剂师主导的药物审查以及采用数字技术来加强教育和支持减量。

结论

本研究确定了影响术后疼痛管理和阿片类药物使用的关键障碍和促进因素。必须采取有针对性的干预措施来优化这些结果。主要建议包括实施由药剂师主导的药物审查、整合数字减量支持工具以及加强术前教育工作。此外,通过专门培训和资源分配来加强沟通渠道并应对劳动力挑战至关重要。未来的研究应评估这些量身定制的干预措施在不同临床环境中的效果,以改善患者结局并完善处方实践。

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