Davies H T, Crombie I K, Macrae W A, Rogers K M, Charlton J E
Department of Epidemiology & Public Health, University of Dundee.
Anaesthesia. 1996 Jul;51(7):641-6. doi: 10.1111/j.1365-2044.1996.tb07845.x.
This audit study took place in ten outpatient pain clinics and focused on the management of low back pain and nerve-damage pain. The objective was to identify and promote appropriate changes in management. An analysis of the treatment of 1236 patients with low back pain and/or nerve-damage pain highlighted wide variations in practice. Presentation of these data to the clinics was used as a means of promoting change. Data on a further 1791 patients were used to assess the extent of any changes in practice. Prior to the audit feedback, treatments were used often in some clinics, but only rarely in other clinics, for seemingly similar patients. During the feedback sessions three treatments were identified for more frequent use by several of the clinics: antidepressant and anticonvulsant drugs, and transcutaneous electrical nerve stimulation. Many changes in practice occurred after the audit intervention, with large increases in the utilisation of these three treatments. Since there is reasonable evidence to support the use of these treatments for chronic pain this represents an improvement in the process of care. The audit demonstrated that patient management can be improved by a combination of active feedback and discussions based around comparisons between centres.
这项审计研究在十家门诊疼痛诊所开展，重点关注下腰痛和神经损伤疼痛的管理。目的是识别并推动管理方面的适当变革。对1236例下腰痛和/或神经损伤疼痛患者的治疗分析突出了实践中的广泛差异。向诊所呈现这些数据被用作推动变革的一种方式。另外1791例患者的数据用于评估实践中任何变化的程度。在审计反馈之前，对于看似相似的患者，某些治疗在一些诊所经常使用，而在其他诊所却很少使用。在反馈会议期间，几家诊所确定了三种更频繁使用的治疗方法：抗抑郁药和抗惊厥药，以及经皮电刺激神经疗法。审计干预后出现了许多实践上的变化，这三种治疗方法的使用率大幅提高。由于有合理证据支持将这些治疗方法用于慢性疼痛，这代表了护理过程的改善。审计表明，通过积极反馈以及围绕各中心之间比较展开的讨论相结合，可以改善患者管理。
