Increasing access to pain care services to improve rural pain management: a realist review investigating factors affecting uptake, implementation, and sustainability.

IF 5.9 1区 医学 Q1 ANESTHESIOLOGY PAIN® Pub Date : 2025-01-21 DOI:10.1097/j.pain.0000000000003482
Ashley R Grant, Gill Westhorp, Carolyn M Murray, Lenore de la Perrelle, Pascale Dettwiller, Andrew Davey, Abbie Norrish, Sandra Walsh, Gretchen Scinta, Emma L Karran, Peter D Hibbert, G Lorimer Moseley
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Abstract

Abstract: Guideline-based care for chronic pain is challenging to deliver in rural settings. Evaluations of programs that increase access to pain care services in rural areas report variable outcomes. We conducted a realist review to gain a deep understanding of how and why such programs may, or may not, work. Our review incorporated interest-holder input in all review phases. We conducted CLUSTER searching to identify literature relevant to understanding the factors affecting the uptake, implementation, and sustainability of programs offering pain care services to rural general practitioners. We used retroductive analysis to generate and test context-mechanism-outcome configurations. Our results are informed by 74 studies. We identified that awareness of the program, provision of necessary resources, and positive attitudes towards the program are required to enable program uptake. When looking for suitable patients to refer, general practitioners need to trust their ability to discuss a referral with a patient in their allocated appointment time. Program sustainability requires clear roles for all providers and sufficient program coordination. Increased access to pain care services enabled interprofessional learning that increased local providers' confidence to manage chronic pain. Many barriers can interfere with successful uptake, implementation, and sustainability of programs that increase access to pain care services in rural settings. It is important to tailor rural workforce programs to local community needs to increase the likelihood of success. Our findings include recommendations for future program planners to consider.

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增加获得疼痛护理服务以改善农村疼痛管理:一项现实主义审查,调查影响摄取、实施和可持续性的因素。
摘要:基于指南的慢性疼痛护理在农村地区具有挑战性。对增加农村地区获得疼痛护理服务的项目的评估报告了不同的结果。我们进行了一次现实主义的回顾,以深入了解这些计划如何以及为什么可能起作用,或者可能不起作用。我们的审查在所有审查阶段都纳入了利益持有人的意见。我们进行了聚类检索,以确定与理解影响向农村全科医生提供疼痛护理服务的项目的吸收、实施和可持续性的因素相关的文献。我们使用回溯分析来生成和测试上下文-机制-结果配置。我们的结果来自74项研究。我们认识到,对项目的认识、提供必要的资源和对项目的积极态度是使项目能够被接受的必要条件。当寻找合适的病人转诊时,全科医生需要相信他们有能力在分配的预约时间内与病人讨论转诊。项目的可持续性需要所有提供者明确的角色和充分的项目协调。增加了获得疼痛护理服务的机会,使跨专业学习成为可能,增加了当地提供者管理慢性疼痛的信心。许多障碍可能会干扰成功的吸收、实施和可持续性规划,以增加农村地区获得疼痛护理服务的机会。重要的是要根据当地社区的需要调整农村劳动力计划,以增加成功的可能性。我们的研究结果包括对未来项目规划者的建议。
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来源期刊
PAIN®
PAIN® 医学-临床神经学
CiteScore
12.50
自引率
8.10%
发文量
242
审稿时长
9 months
期刊介绍: PAIN® is the official publication of the International Association for the Study of Pain and publishes original research on the nature,mechanisms and treatment of pain.PAIN® provides a forum for the dissemination of research in the basic and clinical sciences of multidisciplinary interest.
期刊最新文献
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