加拿大《安全有效使用阿片类药物治疗慢性非癌性疼痛指南》(COG)是针对加拿大阿片类药物相关医院就诊率和死亡率上升而制定的。阿片类药物对慢性非癌性疼痛(CNCP)的益处不确定。出版后,我们编制了可评估结局列表,以评估本指南对实践和患者结局的影响.
麦克马斯特大学国家疼痛中心的一个工作组使用改良的Delphi方法构建了一个临床和患者结果列表,这对于评估COG的摄取和应用非常重要。然后,一个咨询小组审查了这份清单,以确定每个结果的相关性和可行性,并确定了潜在的数据源。国家学院对该指南进行了审查,以及包括COG创建者在内的国家咨询小组,最终列出了5个优先结果。
五种结果被认为是临床重要的和可行的测量:1)阿片类药物对CNCP的生活质量的影响,2)在开始阿片类药物治疗之前评估患者的成瘾风险,3)监测阿片类药物治疗患者的异常药物相关行为,4)与处方阿片类药物过量相关的死亡率和5)在开始CNCP的阿片类药物治疗之前与患者使用治疗协议。这些结果的数据源包括患者的医疗图表,阿片类药物经理,处方监测计划和管理数据库。
测量最佳实践指南的影响并不常见。未来的研究应考虑捕获本研究中确定的五个结果,以评估COG在促进CNCP循证使用阿片类药物方面的影响。
The Canadian
Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). Following publication, we developed a list of evaluable outcomes to assess the impact of this
guideline on practice and patient outcomes.
A working group at the National Pain Centre at McMaster University used a modified Delphi process to construct a list of clinical and patient outcomes important in assessing the uptake and application of the COG. An advisory group then reviewed this list to determine the relevance and feasibility of each outcome, and identified potential data sources. This feedback was reviewed by the National Faculty for the
Guideline, and a National Advisory Group that included the creators of the COG, resulting in the final list of 5 priority outcomes.
Five outcomes were judged clinically important and feasible to measure: 1) Effects of opioids for CNCP on quality of life, 2) Assessment of patient\'s risk of addiction before starting opioid therapy, 3) Monitoring patients on opioid therapy for aberrant drug-related behaviour, 4) Mortality rates associated with prescription opioid overdose and 5) Use of treatment agreements with patients before initiating opioid therapy for CNCP. Data sources for these outcomes included patient\'s medical charts, e-Opioid Manager, prescription monitoring programs and administrative databases.
Measuring the impact of best practice
guidelines is infrequently done. Future research should consider capturing the five outcomes identified in this study to evaluate the impact of the COG in promoting evidence-based use of opioids for CNCP.