Estudio cuasi experimental de una intervención sobre el manejo farmacológico del dolor crónico no oncológico en atención primaria

Abstract

ObjectiveTo analyse the impact of a formative / informative intervention on the treatment of non-oncological chronic pain in Primary Care. DesignQuasi-experimental study before-after, and follow-up of the patient cohort. Location64 Primary Care teams/centres (770 physicians). ParticipantsPatients≥14 years without an oncological diagnosis on: 1) fentanyl citrate, 2) major opioids and≥2 anxiolytics-hypnotics, 3) long-term major and minor opioids, 4) transdermal lidocaine, out of indication. InterventionDissemination of recommendations for the treatment of non-oncological chronic pain and the reporting of the incidents of their patients to each doctor. Main measurementsNumber of incidents in 2 cross sections (June 2017 and June 2018). Number of incidents in June 2017, which were maintained in June 2018 (prospective cohort). ResultsOf the 2,465 incidents detected in 2017, there was a 21.1% reduction after the intervention. The reduction was higher (61.8%, p<.001) in the prospective cohort. In absolute values, the most important reduction was in incidences of lidocaine patches outside of indication (1,032 incidences). The approved indication was found in less than 8% of the treated patients. ConclusionsThe intervention reduced the number of patients with incidences, and this reduction was higher in the prospective cohort, confirming the efficacy of sending information about patients with incidences to their physicians. The incorporation of new treatments during the follow-up year was significant, so these interventions should be perpetuated over time.