امروز : سه شنبه 22 آبان 1397 Rss | صفحه اصلی دانشکده
25 مهر 1395

بررسی رابطه فاکتورهای دموگرافیک در بیماران مبتلا به دردهای مزمن با چگونگی کنترل درد آنها در سطوح اول و دوم خدمات بهداشتی درمانی

درد مزمن سومین مشکل عمده بهداشتی در جهان به شمار می رود. مطالعات انجام شده بر روی این مشکل نشان دهنده تاثیر فاکتورهای اجتماعی-اقتصادی بر روی کیفیت خدمات درمانی ارائه شده جهت مدیریت درد می باشند. آنچه تاکنون به طور گسترده ای مطالعه نشده است میزان کفایت درمان درد مزمن بیماران در سطح اولیه مراقبت های بهداشتی می باشد. اهداف : قصد نمودیم در این مطالعه به بررسی کیفیت مدیریت درد برای اقلیت ها و زیرگروه های مختلف از نظر پارامترهای دموگرافیک در جمعیت بالغین دچار دردهای مزمن در مراکز سطح اول و دوم مراقبت درد بپردازیم. روش انجام کار : در این پژوهش مقطعی بیماران 18 تا 70 ساله ای که برای اولین بار از فروردین سال 1392 تا فروردین سال 1393 با شکایت درد مزمن (طولانی تر از 3 ماه) به مرکز چند تخصصی درد در بیمارستان امام خمینی، وابسته به دانشگاه علوم پزشکی تهران مراجعه کردند وارد مطالعه شدند. اطلاعات مورد نیاز برای این پژوهش در شرح حال گرفته شده از بیماران جمع آوری برای هر بیمار ثبت شد. کفایت مدیریت درد براساس اندکس مدیریت درد براساس توان داروهای تجویز شده برای درد، تعداد کلی داروهای تجویز شده و میزان شدت درد بیماران تعیین شد. سپس ارتباط میان متغیرهای دموگرافیک و کفایت مدیریت درد بیماران مورد ارزیابی قرار گرفت. نتایج : در مجموع 511 بیمار با شکایت درد مزمن وارد مطالعه شدند. از نظر مشخصات دموگرافیک عمده بیماران بین 45 تا 65 سال داشتند (39.1%)، مونث بودند (58.1%)، در گروه افراد بیکار قرار داشتند (61.1%)، تحصیلات کمتر از دبیرستان داشتند (38.2%)، متاهل بودند (80.0%)، با فرد دیگری زندگی می کردند (93.9%) و بیش از 2 فرزند داشتند (53.0%). طبق نتایج آنالیزهای انجام شده جهت شناسایی ریسک فاکتورهای عدم مدیریت مناسب درد سن 45 تا 65 سال (p<0.05, OR=2.71)، جنس مونث (p<0.05, OR=1.64) و سطح تحصیلات بالاتر از کارشناسی (p<0.05, OR=0.32) به طور معناداری با مدیریت نامناسب درد مزمن بیماران ارتباط داشتند.   نتیجه گیری نهایی : گروه سنی 45 تا 65 سال و جنس مونث شانس بیشتری برای مواجهه با مدیریت نامناسب درد دارند. از سوی دیگر سطح تحصیلات بالاتر از کارشناسی به عنوان فاکتوری محافظت کننده در برابر مدیریت نامناسب درد شناسایی شد. کلمات کلیدی : درد مزمن، مشخصات دموگرافیک، مدیریت نامناسب درد، کفایت مدیریت درد استاد راهنما جناب آقای دکتر حسین ماجدی اردکانی جناب آقای دکتر سید علی امامی میبدی   استاد مشاور جناب آقای دکتر سید محمد میراسکندری سرکار خانم دکتر مژگان رحیمی   نگارش محمدرضا ناصربیگدلی Title: Evaluating the relation between demographic characteristics of the patients suffering from chronic pain with the adequacy of their pain management in the first and second levels of pain care services   A Thesis Submitted for Partial Fulfillment of the Requirements for the Degree of Doctorate in Medicine By: Mohammadreza Naserbigdeli   Supervisors: Dr. Hossein Majedi Ardakani Dr. Seyyed Ali Emami Meybodi Advisor: Dr. Seyyed Mohammad Mireskandari Dr. Mojgan Rahimi     Abstract:   Introduction: Chronic pain is the world’s third largest health problem. The literature supports differences in the pain experience based upon socio-demographic factors while documenting the impact pain has on both the individual and society. To our knowledge, this is the first study in our young diverse population to provide evidence for inconsistencies and disparities in pain management based upon socio-demographic parameters in the initial assessment at a tertiary care pain center. Aims: The overriding goal for this study is to explore the adequacy of the quality of the pain management for minorities and different socio-demographic subgroups of our adult population with chronic pain upon initial presentation to a tertiary care pain center. Materials and Methods: All new patients between 18 to 70 years old meeting the criteria for chronic pain (pain for more than 3 months) and attending the Multidisciplinary Pain Center (MPC; a tertiary care pain center) upon initial presentation for chronic pain management were recruited. Self-report information was collected at initial assessment. The adequacy of pain management was evaluated by Pain Management Index (PMI) and the relation between demographic characteristics of the subjects with PMI was assessed. Results: A total of 511 patients with chronic pain were recruited for the survey. Considering demographic characteristics, the majority of patients were aged 46 to 65 years old (39.1%), were female (58.1%), were unemployed (61.1%), had an educational level of less than high school (38.2%), were married (80.0%), were living with someone (93.9%) and had more than two children (53.0%). Based on the analyses performed to identify independent risk factors for mismanagement of pain, age group of 45 to 65 (p<0.05, OR=2.71), female gender (p<0.05, OR=1.64) and educational level of higher than bachelor’s degree (p<0.05, OR=0.32) were found to be significantly related with inadequate pain management.    Conclusion: Patients aged 45-65 years old and females had higher odds of being mismanaged for their chronic pain. On the other hand, educational level of higher than bachelor’s degree was found to have a protective effect against inadequate pain management.    Keywords: Chronic pain, socio-economic status, mismanagement, adequacy of treatment           فهرست منابع     1.         Simon LS. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Journal of Pain & Palliative Care Pharmacotherapy. 2012;26(2):197-8. 2.         Health UDo, Services H. 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