"IT's too much to do alone": A mixed-methods exploration of patient experiences implementing emergency department management plans for chronic pain.

IF 1.5 Q3 RHEUMATOLOGY Musculoskeletal Care Pub Date : 2024-03-01 DOI:10.1002/msc.1874
Bernadette Brady, Sheng Min Pang, Sarah Dennis, Lucy Chipchase, Pranee Liamputtong, Matthew Jennings, Elise Tcharkhedian, Toni Andary, Natalie Pavlovic, Marguerite Zind, Paul Middleton, Robert Boland
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Abstract

Objectives: To explore the experiences of socio-culturally diverse community members attempting to manage their chronic pain and enact evidence-based management plans following an index Emergency Department (ED) visit.

Methods: A convergent parallel mixed-methods design with qualitative interviews and descriptive analysis was undertaken in two public hospitals in a multicultural region in Sydney, Australia. Consecutive adults were recruited from culturally and linguistically diverse (CALD: n = 45) or Australian-born (n = 45) backgrounds, who presented to the ED for a chronic neuromusculoskeletal pain condition. Consenting participants were prescribed an individualised chronic pain management plan following examination by a physiotherapist, who collected standardised measures of pain and health literacy. Six months later, participants underwent a structured phone survey regarding their pain status and whether they had actioned management plans. Participants were invited to participate in a semi-structured interview.

Results: Six-month data were available for 82 of 90 participants who attended the ED and consented to the baseline assessment (40 CALD and 42 Australian-born). Participants were 52% females, predominately middle-aged (mean age 54.7 years), with an overall mean symptom duration of 10 years (SD 9.0). At 6 months, there were nine representations by six CALD participants and 23 by nine Australian-born participants. Overall, 52% reported unchanged pain, 24% were worse and 23% improved, with similar action plan progress for CALD (58%) and Australian-born (53%) participants. Pain features and health literacy were similar, irrespective of progress with pain management plans. From 41 participants who consented to phone interviews, three themes emerged to explain their progress with recommendations: 'illness model', 'urgency' and 'control orientation'.

Conclusions: Patients presenting to the ED with chronic pain might be more likely to action discharge recommendations if primary care providers identify patient-specific and contextual barriers to implementation.

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"一个人做的事情太多了":对急诊科慢性疼痛管理计划实施过程中患者体验的混合方法探索。
目的探讨不同社会文化背景的社区成员在急诊科就诊后试图管理其慢性疼痛并制定循证管理计划的经历:方法: 在澳大利亚悉尼多元文化地区的两家公立医院中,采用并行混合方法设计,进行定性访谈和描述性分析。连续招募了来自不同文化和语言背景(CALD:n = 45)或在澳大利亚出生(n = 45)的成年人,他们因慢性神经肌肉骨骼疼痛到急诊室就诊。获得同意的参与者在接受理疗师检查并收集标准化的疼痛和健康知识测量数据后,将接受个性化的慢性疼痛管理计划。6 个月后,参与者接受了一次结构化电话调查,了解他们的疼痛状况以及是否执行了管理计划。参与者还受邀参加了半结构化访谈:在 90 名到过急诊室并同意接受基线评估的参与者中,有 82 人(40 名 CALD 和 42 名澳大利亚出生者)接受了为期 6 个月的数据采集。参与者中女性占 52%,以中年人为主(平均年龄 54.7 岁),症状持续时间平均为 10 年(标清 9.0)。6 个月时,6 名 CALD 参与者有 9 次陈述,9 名澳大利亚出生的参与者有 23 次陈述。总体而言,52%的人表示疼痛没有改变,24%的人表示疼痛加重,23%的人表示疼痛有所改善,CALD(58%)和澳大利亚出生的参与者(53%)的行动计划进展情况相似。无论疼痛管理计划的进展如何,疼痛特征和健康素养都相似。在 41 位同意接受电话访谈的参与者中,有三个主题可以解释他们在落实建议方面的进展情况:结论:结论:如果初级医疗服务提供者能识别患者的具体情况和实施障碍,慢性疼痛急诊患者可能更有可能执行出院建议。
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来源期刊
Musculoskeletal Care
Musculoskeletal Care RHEUMATOLOGY-
CiteScore
2.30
自引率
7.70%
发文量
88
期刊介绍: Musculoskeletal Care is a peer-reviewed journal for all health professionals committed to the clinical delivery of high quality care for people with musculoskeletal conditions and providing knowledge to support decision making by professionals, patients and policy makers. This journal publishes papers on original research, applied research, review articles and clinical guidelines. Regular topics include patient education, psychological and social impact, patient experiences of health care, clinical up dates and the effectiveness of therapy.
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