多学科协作癌痛整合门诊的实施与管理

Implementation and Management of Integrated Multidisciplinary Cancer Pain Clinic

目的探讨专科医院多学科协作癌痛整合门诊的运营管理模式,为解决“看病难”问题提供参考。方法同济大学附属上海市肺科医院于2013年起构建癌痛整合门诊一站式多学科协作诊疗模式,由肺内科医师、麻醉师、临床药师、疼痛专科护士兼国家二级心理咨询师组成,通过绿色通道实现癌痛问题的快速检查、诊断及解决;并建立个人档案,登记“疼痛筛查表”,由疼痛专科护士每周电话随访实施疼痛跟踪管理和延续护理。通过调查2018-2021年就诊于癌痛整合门诊的308例患者,了解其就医体验并评价癌痛门诊实施效果。结果患者就医体验总体满意度为96.4%;认为一次性达到就医目的者占88.3%、认为诊治及时合理者占87.3%、认为居家康复护理指导及时者占78.6%;53.9%的患者认为门诊费用价格适中。结论与目前分科精细化的诊疗模式相比,多学科癌痛整合门诊为患者提供了一站式的便捷快速诊疗服务,可有效解决看病难的问题,提升了患者的就医满意度,值得临床推广。

Objective To explore an operation and management mode of integrated multidisciplinary cancer pain clinics in specialized hospitals,providing a reference for solving the difficulties of getting medical service.Methods Since 2013,Shanghai Pulmonary Hospital Affiliated to Tongji University has established an integrated cancer pain clinic that applied a one-stop multidisciplinary diagnosis and treatment model and was composed of pulmonary physicians,anesthetists,clinical pharmacists,pain nurse specialists and national second-level psychological counselors.Through the green channel,the physicians would examine,diagnose and solve the cancer pain,then establish personal files,and register the"Pain Screening Inventory";the pain nurse specialists would follow up the pain management and transitional care on the phone once a week.A total of 308 patients who visited the integrated cancer pain clinic during 2018-2021 were investigated to understand their medical experience and evaluate the therapeutic effect of the cancer pain clinic.Results The overall satisfaction rate of the patients was 96.4%,88.3%of them thought that their purpose of medical treatment was achieved at one time,87.3%of them thought that the diagnosis and treatment were timely and reasonable,78.6%of them thought that the nursing guidance on home-based rehabilitation was timely,and 53.9%of them thought that the cost of clinic service was moderate.Conclusion Compared with the precise diagnosis and treatment mode currently applied,the integrated multidisciplinary cancer pain clinic provides one-stop,convenient and rapid diagnosis and treatment services for patients,which can effectively solve the difficulties of getting medical service and improve patients’satisfaction with medical treatment,so it is worthy of clinical promotion.