Shared Decision-Making in the Selection of Outpatient Analgesics for Older Individuals in the Emergency Department

• Autores: Cameron G. Isaacs, Christine E. Kistler, Katherine M. Hunold, Greg F. Pereira, Mara Buchbinder, Mark A. Weaver, Samuel A. McLean, Timothy F. Platts Mills
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 61, Nº. 5, 2013, págs. 793-798
• Idioma: inglés
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• Resumen

  • Objectives: To assess the relationship between older adults' perceptions of shared decision-making in the selection of an analgesic to take at home for acute musculoskeletal pain and (1) patient satisfaction with the analgesic and (2) changes in pain scores at 1 week.

    Design: Cross-sectional study.

    Setting: Single academic emergency department.

    Participants: Individuals aged 65 and older with acute musculoskeletal pain.

    Measurements: Two components of shared decision-making were assessed: information provided to the patient about the medication choice and patient participation in the selection of the analgesic. Optimal satisfaction with the analgesic was defined as being �a lot� satisfied. Pain scores were assessed in the ED and at 1 week using a 0-to-10 scale.

    Results: Of 159 individuals reached by telephone, 111 met all eligibility criteria and completed the survey. Fifty-two percent of participants reported receiving information about pain medication options, and 31% reported participating in analgesic selection. Participants who received information were more likely to report optimal satisfaction with the pain medication than those who did not (67% vs 34%; P < .001). Participants who participated in the decision were also more likely to report optimal satisfaction with the analgesic (71% vs 43%; P = .008) and had a greater average decrease in pain score (4.1 vs 2.9; P = .05). After adjusting for measured confounders, participants who reported receiving information remained more likely to report optimal satisfaction with the analgesic (63% vs 38%; P = .04).

    Conclusion: Shared decision-making in analgesic selection for older adults with acute musculoskeletal pain may improve outcomes.