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首页> 外文期刊>BMC Geriatrics >Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study
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Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

机译：初级保健提供者对患有慢性非癌性疼痛的老年人开处方阿片类药物的观点：一项定性研究

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Background The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Results Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Conclusions Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.
机译：背景技术阿片类药物作为慢性非癌性疼痛的治疗方法仍存在争议。目前，关于老年人中医疗保健提供者对此行为的态度和信念的信息很少。这项研究旨在描述初级保健提供者对阿片类药物处方治疗老年人的慢性疼痛的经验和态度，以及所认识到的障碍和促进因素。方法进行了六个焦点小组的研究，由来自纽约市两个学术附属初级保健实践和三个社区卫生中心的23位医生和3位护士从业人员进行。焦点小组被录音和转录。使用定向内容分析法分析数据; NVivo软件用于协助确定主题的量化。结果大多数参与者（96％）采用阿片类药物作为其一些慢性疼痛老年患者的疗法，尽管不是一线疗法。提供者列举了多种障碍，包括害怕造成伤害，痛苦的主观性，缺乏教育，阿片类药物之间的转换问题以及污名。新的障碍包括患者/家庭成员不愿尝试阿片类药物以及对家庭成员/看护者滥用阿片类药物的担忧。证实治疗获益的研究，用于评估合并症的风险和/或剂量的经过验证的工具，改进的转换方法，患者的教育以及同伴的支持可以促进阿片类药物的处方。与对慢性疼痛患者的护理相比，参与者在提供姑息或临终关怀护理的环境中使用阿片类药物感到更加舒适，并对慢性疼痛的治疗感到沮丧。结论提供者认为向患有慢性疼痛的老年人开处方阿片类药物有多种障碍，因此应谨慎使用这些药物。建立这些药物的长期安全性和有效性，产生改进的处方方法，以及实施提供者和患者的教育干预措施，可能有助于改善以后生活中慢性疼痛的管理。

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