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背景自我管理是被推崇的慢性疼痛干预方法。有效地自我管理可以减少疼痛对患者日常生活的影响。临床指南指出初级保健服务有助于慢性疼痛患者的自我管理。目的分析初级保健专业人员、慢性疼痛患者及其照顾者对慢性疼痛自我管理的意见,在此基础上探究不利于应用和开展慢性疼痛自我管理的因素。设计与场所此项定性研究在苏格兰开展,研究对象为数个专题小组。方法共有18个小组参与专题讨论,包括54名慢性疼痛患者、9名慢性疼痛患者的照顾者以及38名初级保健专业人员。结果通过分析各小组的观点,得出4类不利于慢性疼痛自我管理的因素:(1)不和谐的医患沟通:部分患者认为自我管理慢性疼痛已经为时过晚或者不重要。医生和患者很难沟通,难以构建良好的医患关系;(2)患者体验:由于没有设身处地地考虑慢性疼痛对患者情绪的影响,使得患者常觉得初级保健专业人员对他们的治疗不积极;(3)有限的治疗方案:一些研究对象感觉治疗有过度医疗化的倾向;(4)机构的组织管理缺点:医生用于诊疗患者的时间短,患者候诊时间长,以及英国国家医疗服务体系实行的分级诊疗带来的看病困难问题。结论此项研究分析了应用与开展慢性疼痛自我管理所面临的挑战。如果自我管理是治疗慢性疼痛的一种重要方法,初级保健专业人员需要找到解决不利因素的方法,以使其顺利应用与开展。
Background Self-management is a well-respected method of chronic pain intervention. Effective self-management can reduce the impact of pain on the patient’s daily life. Clinical guidelines point out that primary care services contribute to the self-management of patients with chronic pain. Objective To analyze the opinions of primary care professionals, patients with chronic pain and their caregivers on self-management of chronic pain, and to explore the factors that adversely affect the application and self-management of chronic pain. Design and Locations This qualitative study was conducted in Scotland with several focus groups. Methods A total of 18 groups participated in the panel discussion, including 54 patients with chronic pain, 9 caregivers with chronic pain, and 38 primary health care professionals. Results By analyzing each group’s perspective, four types of factors were found to be detrimental to chronic pain self-management: (1) Disharmony of physician-patient communication: Some patients consider self-management of chronic pain too late or insignificant. (2) Patient experience: Because of the lack of consideration of the effect of chronic pain on the emotion of patients, patients often feel that primary health care professionals are not active in their treatment; (2) 3) limited treatment options: some subjects have a tendency toward over-treatment of sensory therapy; 4) institutional management of the organization Disadvantages: short periods of time for doctors to treat patients, long waiting times for patients, and implementation of the British National Health Service Grading diagnosis and treatment of difficult problems. Conclusions This study analyzes the challenges of applying and developing self-management of chronic pain. If self-management is an important method of treating chronic pain, primary care professionals need to find ways to tackle them, so that they can be used and implemented successfully.