Merlin T, Hiller J; Health Technology Assessment International. Meeting (1st : 2004 : Krakow, Poland).
Proc One HTA Health Technol Assess Int Meet 1st 2004 Krakow Pol. 2004; 1: 232.
Department of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
OBJECTIVE: To assess the effectiveness of "institutionalised" pain assessment and management programs, where pain control is integrated into the culture or "fabric" of an organisation. METHODS: Medline, Embase, the Cochrane Library and other databases and internet sites were searched for relevant literature (1995-2002). Specialty journals and bibliographies were hand searched. Two researchers independently selected studies using pre-specified criteria. Studies were assessed for susceptibility to bias, clinical importance and relevance. Data were then extracted. Of the included studies, one was comparative and 21 were uncontrolled before-and-after studies. RESULTS: The assessment and documentation of patient pain occurred more commonly in facilities with institutionalised pain assessment and management. However, the impact on patient pain intensity ratings and on the proportion of patients with moderate to severe pain was neither consistent nor clinically important. Apparent increases in patient satisfaction with pain management and improvements in patient functional ability were not clinically important according to predetermined criteria. However, clinically and statistically significant increases were seen in the use of patient-controlled or intravenous analgesia, whilst intramuscular administration of analgesia decreased substantially. Institutional approaches facilitated consistent reductions in meperidine usage and in several analgesia-related adverse effects. Non-pharmacologic methods of pain relief increased. DISCUSSION: Predominantly lower level evidence suggests that pain relief may still be an issue after institutional approaches are implemented. However, improvements in pain assessment, patient satisfaction with pain management, analgesia prescribing and administration practices, and reductions in analgesia-related adverse effects are promising. Institutional pain assessment and management programs should be piloted by health care providers, under controlled conditions.
Publication Types:
Keywords:
- Analgesia
- Bias (Epidemiology)
- Humans
- Pain
- Pain Clinics
- Pain Measurement
- Patient Satisfaction
- United States
- methods
- hsrmtgs
UI: 103140861
From Meeting Abstracts