Asmeskas cov laus tau tawm tsam nrog kev tsim txom
Ntawm xyoo 2000 txog 2014, ze li ib nrab lab tus neeg tuag los ntawm kev siv tshuaj ntau dhau , 165,000 ntawm cov neeg ua los ntawm cov tshuaj narcotics . Hauv xyoo 2016, nws tau kwv yees tias 78 Asmesliskas tau tuag vim kev tsim txom los ntawm kev ua phem rau txhua hnub. Ib nrab ntawm cov kev tuag ntawm kev tuag ntawm opioid yog raug rau cov tshuaj noj.
Nws tsis muaj teeb meem yog tias koj tseem hluas los yog hnub nyoog, nplua nuj los yog tsis zoo, kev tsim txom los ntawm opioid yog ib qho teeb meem uas yuav tsum tau hais los ntawm Tebchaws Meskas loj.
Yuav ua li cas Teb Chaws Asmeskas Tsab Teev Ntaus Hom Tshuaj
Cov Chaw Rau Kev Tswj thiab Kev Tiv Thaiv Kab Mob (CDC) qhia tias kev tuag ntau dhau los ntawm cov tshuaj tiv thaiv tau ntau tshaj plaub lub hlis txij li xyoo 1999. Interestingly, kev siv cov tshuaj opioids kuj tau siv plaub lub sij hawm no.
Puas yog Amelikas txoj kev saib xyuas kev noj qab haus huv ua txhaum?
Lub Chaw Saib Xyuas Kev Yeeb Tshuaj (DEA) muab tshuaj rau ib qho ntawm tsib yam txawv, uas yog hu ua Schedules. Cov kev tuaj yeem kuv txog V piav qhia tias kev siv tshuaj puas tsim nyog rau kev siv tshuaj kho mob nyob rau qee qhov kev mob thiab txawm tias nws tsis muaj peev xwm .
- Teem Caij Kuv: Tsis muaj kev siv kev kho mob, muaj peev xwm ua tau ntau yam
- Lub Sij Hawm II: Kev siv tshuaj kho mob, kev muaj yees zoo siab
- Sij hawm III: Kev siv tshuaj kho mob, muaj kev sib ntxub kom tsawg li tsawg tau
- Lub Sij Hawm IV: Kev siv tshuaj kho mob, kev txo qis qis
- Teem sijhawm V: Kev siv tshuaj kho mob, txo qis tshaj plaws
Nws yuav tsum tsis muaj surprise tias tus nees ej raws li hauv Schedule kuv (interestingly, yog li yeeb tshuaj xas ).
Cov tshuaj opioids uas tau poob rau hauv Schedule II yog codeine, fentanyl (Sublimaze, Duragesic), hydromorphone (Dilaudid), methadone, meperidine (Demerol), morphine, thiab oxycodone (OxyContin, Percocet). Daim Ntawv Teev Tseg III narcotics muaj xws li cov khoom siv ua ke uas muaj tsawg dua 15 milligram ntawm hydrocodone ib koob (Vicodin), cov khoom muaj tsawg dua 90 milligrams of codeine ib zaug (Tylenol nrog Codeine), thiab buprenorphine (Suboxone) .
Koj puas tau raug xaiv ib qho ntawm cov tshuaj no?
Pharmaceuticals Companies Minimize qhov txaus ntshai rau kev quav tshuaj
Nyob rau xyoo 2001, Cov Kev Koom Tes Ua Haujlwm ntawm Cov Koom Haum Kho Mob (JCAHO) tau tso tawm thawj daim ntawv qhia txog kev tswj kev mob. Kev xav ua kom paub txog kev mob ntawm kev kho mob thiab kho kom zoo dua qub, JCAHO tau tawm tswv yim uas cuam tshuam li cas lub tsev kho mob tau saib xyuas, hais lus thiab kho mob.
Vim li ntawd, qhov mob ntawm qhov mob tuaj rau hauv lub neej, thiab muaj coob tus neeg paub txog kev tswj kev mob. Tias, nyob rau hauv thiab ntawm nws tus kheej, yog qhov zoo tshaj plaws. Tsis muaj leej twg yuav tsum mob. Cov teeb meem, txawm li cas los xij, yog tias muaj coob tus neeg tsis to taub txog kev tswj kev mob qhov twg txog txhua yam. Nws meant kev txhim kho mob, tsis tas nqa cov theem mob mus rau "0" ntawm 0-10 teev. Kev tshem tawm ntawm qhov mob tsis yog ib txwm ua tau. Nrog rau qhov kev tuaj yeem ua rau lub tsev kho mob kom muaj kev vam meej.
Thaum JCAHO tsis tau qhia rau cov kws kho mob kom paub kho qhov mob, muaj kev txhawj xeeb ntawm cov ntaub ntawv uas lub Koom Haum tau muab faib los ntawm Purdue Pharma, qhov chaw ua lag luam uas ua rau OxyContin . Cov ntaub ntawv txo cov kev sib txuas ntawm kev siv tshuaj tua kab mob thiab kev quav tshuaj.
Cov kws tshuaj sawv cev rau lub tuam txhab tau mus kom deb li hais tias qhov kev pheej hmoo ntawm qhov kev tiv thaiv yog "tsawg tshaj li ib feem" thaum nws paub ntev tias qhov kev pheej hmoo ntawm kev tsim txom hauv cov neeg mob cancer tsis zoo txog li ntawm 50 feem pua. Qhov tseeb, Purdue Pharma tau pom tias muaj kev ua txhaum kev lagluam thiab raug nplua $ 634 lab.
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias Joint Commission tsis faib cov ntaub ntawv rau cov neeg ua haujlwm kho mob, tab sis puas tau muaj kev puas tsuaj lawm? JCAHO hais tias kev siv cov tshuaj opioid siv yog nyob rau ntawm qhov nce ua ntej lawv tso tawm lawv daim ntawv qhia tab sis nws tseem ceeb heev kom nco ntsoov tias nws tau nce ntxiv tom qab ntawm qhov mob ntawm qhov mob.
Tsoomfwv Tsoomfwv Cov Cai Kaw Npe Tau Thaiv Opioid
Hauv xyoo 2006, Cov Chaw rau Medicare thiab Medicaid Kev Pabcuam (CMS) tau pib lub Tsev Kho Mob Tus Neeg Kho Mob Kev Kho Mob thiab Lub Nruab Nrab (HCAHPS). Qhov kev tshawb fawb tau siv ua ib txoj hauv kev ntsuam xyuas tsev kho mob kev ua tau zoo thiab tau ua tiav los ntawm cov neeg mob raws li lawv qhov kev paub thaum lub sijhawm lawv pw hauv tsev khomob.
HCAHPS nrog rau cov lus nug txog kev tswj kev mob ntawm tus mob: "Koj tau mob npaum li cas koj tus mob zoo?" thiab "Muaj ntau zaus cov neeg ua haujlwm hauv tsev kho mob ua txhua yam lawv ua tau los pab rau koj txoj kev mob?" Cov lus teb yog cov lus nug thiab tsis tas sawv cev rau tus neeg mob tau txais kev tswj hwm kev mob lossis yog qhov kev kho mob yog qhov tsim nyog tshaj plaws. Tus neeg mob uas yuav tsum tau "0" ntawm qhov ntsuas ntawm qhov mob yuav piv tau ib lub tsev kho mob nrog tus qhab nia qis qis txawm tias nws qhov mob zoo dua li nws nyob. Txawm li ntawd los, nws yog ib kauj ruam hauv txoj kev xav kom hnov cov neeg mob xav li cas.
Qhov teeb meem? Cov qhab nias ntawm HCAHPS tau txuas rau kev them nqi kho mob hauv tsev kho mob. CMS yuav them cov tsev kho mob ntau dua yog tias lawv tau qhab nees siab dua. Thaum lub sij hawm CMS ntiav cov lus nug txog kev mob ntawm lub cev tau pab tsawg los them, qhov tseeb yog tias lawv tau muaj. Qhov kev txhawj xeeb yog tias qee cov neeg ua haujlwm kho mob muaj peev xwm tau muaj kev nyuab siab los muab cov opioids los ua cov qhab nias dua.
Paub zoo tias HCAHPS yuav pab tau kom siv cov tshuaj opioid ntau dua, CMS muaj txij li thaum tshem tawm cov lus nug txog kev mob ntawm qhov mob ntawm lawv cov nyiaj them rov qab. Cov ntaub ntawv tseem khaws tau, tabsis, los pab cov tsev kho mob kom zoo dua kev saib xyuas thiab kev tswj kev mob.
Medicare Kev Siv Cov Tshuaj Kho Mob Ntxiv
Ib txoj kev kawm 2016 hauv JAMA Internal Medicine tau tsa cov tsom iav thaum nws qhia tias Medicare cov neeg tau txais kev pabcuam raug xaj tshuaj rau cov tshuaj opioid tsis zoo tom qab tsev kho mob tas. Tshwj xeeb tshaj li, cov neeg tshawb nrhiav tau rov mus xyuas tsev kho mob rau li ntawm 623,000 tus neeg tau txais Medicare hauv xyoo 2011.
Cov neeg tau txais kev pab no tsis tau ua ntej rau cov tshuaj noj opioid, tsawg kawg tsis yog rau 60 hnub ua ntej lawv nyob hauv tsev khomob. Ze li ntawm 15 feem pua ntawm lawv tau sau daim ntawv xaiv tshuaj opioid tshiab li ntawm ib lim tiam ntawm tsev kho mob thiab 42.5 feem pua ntawm lawv cov tshuaj noj ntev tshaj 90 hnub.
Rau txhua tus neeg uas tau nug tias HCAHPS tsis cuam tshuam txog cov tshuaj kws kho mob sau, cov kev tshawb fawb pom muaj kev sib raug zoo ntawm cov neeg mob siab thiab cov tshuaj siv tshuaj kho mob tshiab.
Lwm txoj kev tshawb nrhiav, lub sij hawm no hauv Jama Psychiatry, kuj pom muaj kev sib raug zoo. Cov ntaub ntawv los ntawm Medicare Part D raug soj ntsuam thiab pom tau tias 6 ntawm 1,000 tus neeg tau txais Medicare yuav tau muaj kev tsim txom tsis kam siv tshuaj tua kab mob opioid. Qhov no yog 6-fold nce piv rau cov neeg ntawm lwm cov ntawv kho mob.
Vim li cas Medicare cov neeg tau txais kev pab cuam ntau dua rau kev tsim txom tsis raug cai? Lawv puas muaj mob ntau dua? Puas yog lawv feem ntau yuav raug muab tso rau hauv cov tshuaj tiv thaiv kab mob vim yog, raws li cov laus, lawv yuav muaj tsev kho mob ntau dua? Hais txog qhov no, yog HCAHPS los ua txhaum? Ntau qhov kev tshawb nrhiav peb xav tau kom peb thiaj tuaj yeem tau txais hauv plawv ntawm qhov teeb meem. Peb yuav tsum tsis txhob tsuas yog kev tiv thaiv kev tsim txom siv opioid, tiam sis tseem qhov teeb meem uas ntsig txog nws.
Peb Yuav Ua Dab Tsi Tiv Thaiv Tus Mob Raug Mob?
Cov kab mob opioid tsis yog ib pawg twg. Ntau yam uas tau ua rau lub xeev ntawm kev ua haujlwm, thiab kev sib raug zoo ntawm tsoomfwv, tuam txhab lag luam, kev tuav pov hwm cov koom haum, kev kho mob thiab cov kws kho mob yuav tsum tau ua kom muaj kev hloov zoo. Cov kauj ruam no yuav pab coj peb mus rau txoj kev yog.
- Cov cai thiab cov kev tswjfwm yuav tsum tsis pub qiv nyiaj rau kev kho mob raws li tus neeg mob siab cov qhab nia uas muaj feem xyuam nrog kev siv tshuaj siv tshuaj. Qhov no yuav hloov cov qauv tshuaj rau hauv txoj kev uas nyiam cov nyiaj them dua rau tsev kho mob.
- Kev tshawb nrhiav yuav tsum tau ua kom tsim muaj cov kev kho mob tshiab tsawg dua qub. Cov lag luam kws kho mob thiab lwm tus yuav tsum tau siv cov nyiaj txiag los ua kom muaj kev xaiv ntau ntxiv.
- Cov neeg sab nraud yuav tsum tau nthuav dav cov kev pab kho mob lwm yam. Acupuncture, biofeedback, kev kho zaws, thiab kev kho lub cev, piv txwv li, tau pom txiaj ntsim hauv kev txhim kho mob siab tab sis kev tuav pov hwm tsis tas them lawv.
- Cov kws kho mob yuav tsum tau txais kev cob qhia ntxiv thaum nws tuaj yeem siv cov tswv yim tswj qhov mob thiab siv cov tshuaj opioids.
- Lwm yam kev kho mob yuav tsum raug xam ua ntej tshuaj noj tshuaj thaum tsim nyog. Kev siv cov tshuaj tiv thaiv opioid ua ntej yuav muaj peev xwm ua rau kev siv cov tshuaj no.
- Kev nkag tau rau cov kev pabcuam rau sawvcev (kev txhawb tswvyim, cov tshuaj noj, thiab lwmyam) uas txhawb kev rov qab los ntawm kev tsim txom siv opioid xav tau zoo tuaj. Tib neeg xav tau kev pab, tab sis muaj cov kev pabcuam tsawg muaj rau qhov chaw hais txog qhov teebmeem ntawm qhov teebmeem tam sim no.
> Qhov chaw:
> HHS Tshaj Tawm Tshiab Haujlwm Yuav Tiv Thaiv Opioid Phaum Mob. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Kev Pab Tib Neeg hauv Tebchaws Meskas http://www.hhs.gov/about/news/2016/07/06/hhs-announces-new-actions-combat-opioid-epidemic.html .Published July 6, 2016.
> Jena AB, Goldman D, Karaca-Mandic P. Tsev Kho Mob Sau tshuaj ntawm Opioids rau Medicare Cov Kev Pabcuam. JAMA Intern Med. 2016; 176 (7): 990-997. doi: 10.1001 / jamainternmed.2016.2737.
> Koom Tes Lus Tshaj Tawm rau Kev Tswj Tus Mob. Lub Koom Haum Koom Tes lub website. https://www.jointcommission.org/joint_commission_statement_on_pain_management/. Luam tawm Tim 18, 2016.
> Cov ntawv sau tshuaj ntau dua. Cov Chaw rau Kev Tswj Xyuas Kev Tiv Thaiv thiab Tiv Thaiv lub website. http://www.cdc.gov/drugoverdose/data/overdose.html. Kho lub Rau Hli 21, 2016.
> Zee AV. Kev Taw Qhia thiab Kev Ua Lag Luam ntawm OxyContin: Kev Ua Lag Luam Triumph, Kev Soj Ntsuam Kev Noj Qab Haus Huv. Am J Public Health. 2009 Lub Ob Hlis; 99 (2): 221-227. doi: 10.2105 / AJPH.2007.131714.