健康衛教對疼痛病患門診疼痛處置的適用性

The feasibility of health education service in outpatient pain management

背景及目的：疼痛病患會因為疼痛而降低對醫療滿意度與健康相關的生活品質。本研究之目的在於評估門診之健康衛教對慢性疼痛患者門診疼痛處置的適用性。研究設計：本前瞻性研究於南臺灣某大學教學醫院進行門診疼痛處置的監測。將健康衛教導入門診疼痛處置，將病患分為有衛教與無衛教兩組，各100例，並對病患的疼痛控制情況做紀錄，衛教組病患第一次至門診就診時給予健康衛教，無衛教組則比照疼痛門診評估治療，一個月內並有四次訪視，措施評值以問卷收集資料包括疼痛痛分、病患對疼痛控制之滿意度（五分量表）、和生活品質（五分量表），研究中比較健康衛教前後的上述變項之變化。實驗結果：無衛教與衛教兩組，各有88與90位慢性疼痛病患完成試驗，衛教組藥物順從性，疼痛減少程度，疼痛控制之滿意度都比無衛教組要好。兩組共從第一次至第四次訪視病患疼痛滿意度生活品質都有明顯的改善。研究結論：本試驗結果顯示健康衛教可以提升疼痛慢性病患的藥物順從性與滿意度，所以建議可將疼痛病患健康衛教導入門診治療方案中。

Background: The influence of health service education on quality of pain management was rarely discussed. The purpose of the study was to evaluate the feasibility of health education service in outpatient pain management. Materials and methods: Two hundreds adults who visited the pain clinic were enrolled and allocated into two groups. Group C (n=100) received ordinary outpatient pain management. Group H (n=100) received outpatient pain management program with the health education service at the initial assessment. Four outpatient visits were designed within a one-month follow-up period. Quality of pain management was assessed by patient compliance, pain intensity (Numerical rating scale, NRS), patient satisfaction (5 point scale), physical and mental health (self description) acquired by using questionnaires. Results: Adequate data were recorded and analyzed in 88 patients in group C and 90 in group H. Patient compliance was better in group H than group C (p<0.001). Patients' satisfaction to pain control was better in group H compared to group C at final visit (p=0.04). Pain intensity decreased significantly from first to fourth visit in both groups (both p<0.001). Patient satisfaction, physical and mental health improved significantly in both group C and group H. Conclusion: The introduction of health education service into pain management program was associated with better patient compliance and satisfaction. It also revealed comparable improvement in pain intensity, physical and mental health in outpatient pain management. We suggest routine use of health education services in outpatient treatment of pain.