Document Detail

Clinical pathways can improve the quality of pain management in home palliative care in remote locations: retrospective study on Kozu Island, Japan.
MedLine Citation:
PMID:  23116429     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Recent studies show that a clinical pathway (CP) optimizes pain management in palliative care; however, studies on CPs in home palliative care, especially in remote locations, are scarce. Physicians performing palliative care in remote areas frequently face characteristic difficulties. The CP is an effective tool to overcome these difficulties. This study evaluates the effectiveness of the CP in home palliative care on a remote island.
METHODS: This study reviewed 24 patients (17 in a pre-CP group and seven in a post-CP group) who received home palliative care on Kozu Island in south-eastern Japan from April 2006 to December 2011. To evaluate CP effectiveness, the authors compared patients in whom a rescue opioid was set, and nonsteroidal anti- inflammatory drugs (NSAIDs), antiemetics, and laxatives drug were used with opioids in the post-CP group compared with those in the pre-CP group. To assess pain management quality, authors compared Pain Management Index (PMI) scores on day 1 (baseline); day 8 following CP initiation; and within 3 days before death.
RESULTS: The proportion of patients in whom a rescue dose was set was 100% in the post-CP group versus 46% in the pre-CP group (<em>p</em>=0.04). The proportion of patients in whom NSAIDs were used with opioids was 100% in the post-CP group versus 18% in the pre-CP group (<em>p</em>=0.002). The proportion of patients in whom antiemetics and laxatives were used with opioids was 100% in the post-CP group versus 27% in the pre-CP group (<em>p</em>=0.009). Baseline PMI scores were not significantly different between groups (-1 in post-CP group versus 0 in pre-CP group, <em>p</em>=0.1); however, PMI scores at day 8 and within 3 days before death were significantly higher in the post-CP group (1.9 and 2.9) than in the pre-CP group (0.2 and -0.4) (<em>p</em>=0.007 and <em>p</em>=0.0005, respectively).
CONCLUSION: Implementation of a CP for pain management in home palliative care in remote locations could improve compliance with the WHO pain management guidelines and the quality of pain management.
Yuki Tateno; Shizukiyo Ishikawa
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Publication Detail:
Type:  Journal Article     Date:  2012-11-01
Journal Detail:
Title:  Rural and remote health     Volume:  12     ISSN:  1445-6354     ISO Abbreviation:  Rural Remote Health     Publication Date:  2012  
Date Detail:
Created Date:  2012-11-02     Completed Date:  2013-01-07     Revised Date:  2013-01-25    
Medline Journal Info:
Nlm Unique ID:  101174860     Medline TA:  Rural Remote Health     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  1992     Citation Subset:  IM    
Kozu National Health Insurance Clinic, Tokyo, Japan.
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MeSH Terms
Aged, 80 and over
Analgesics, Opioid / adverse effects,  therapeutic use*
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Antiemetics / therapeutic use
Comparative Effectiveness Research
Critical Pathways / standards*
Health Knowledge, Attitudes, Practice
Home Care Services*
Laxatives / therapeutic use
Middle Aged
Neoplasms / physiopathology,  rehabilitation,  therapy
Nurses / standards
Pain / drug therapy
Pain Management*
Palliative Care / methods*,  utilization
Physicians, Family / standards
Quality Assurance, Health Care / standards*
Retrospective Studies
Rural Health Services / standards*
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antiemetics; 0/Laxatives

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