AUSTIN — An initiative to improve the quality of primary care practices involved in caring for patients with chronic pain (CP) has revealed some misconceptions about the role these physicians play in treating these patients.
Jill Martin Boone, PharmD,of the University of Cincinnati, Ohio, and her colleagues examined two quality improvement models — one was more intensive than the other — that aimed to assess attitudes among primary care practices about patients with chronic pain, and better understand how these physicians treat these patients. The researchers measured outcomes by looking at staff surveys, patient chart reviews, and reviewing electronic health records to document prescriptions.
- Pre- and post-intervention chart reviews and clinician surveys on attitudes and self-efficacy in CP care with written and verbal feedback on the findings to each practice.
- Five academic detailing sessions (pain management, integrative medicine, pharmacy, physical therapy and mental health).
- Intensive quality improvement (QI) support for a practice-selected CP QI project
- Overview of the new electronic health record (EHR) tools to document prescriptions.
Eight of the less intensive intervention groups received only written feedback of chart review and survey responses and notification of new EHR tools.
The more intensive intervention group had significant improvement in selected pain assessments and prescribing monitoring parameters compared to the less intensive.The change in self-efficacy by providers was also significantly higher in the more intensive group. Attitudes toward managing chronic pain patients did not change in either group, according to Dr Boone.
Although both interventions had a positive impact overall, the researchers noted there were “many misperceptions about how pain professionals contribute to” chronic pain care, Dr Boone noted. She explained that primary care physicians (PCPs) often “referred to pain professionals for second opinions, to improve treatment outcomes and when they felt uncomfortable with their own skills. Often the PCP understanding of what the various other professionals had to offer the patient was limited or misunderstood. Other pain professionals, indeed, felt that PCPs had misconceptions of their respective roles in care and often used them ‘as a last resort.’ While all agreed the PCP should be the hub of care, they in general felt underutilized. Other barriers to the use of the various pain consultants included limited availability and restricted insurance coverage. All professionals agreed that patients frequently serve as de facto carriers of communication.”
These misconceptions and barriers are important to explore, she told Clinical Pain Advisor, because “the interprofessional collaborative practice has shown promise to improve outcomes in patients with chronic pain, however, it is often difficult for primary care physicians, who provide most chronic pain care in the US, to practically achieve.”
Both PCPs and pain professionals desired regular, timely communication that focused on key questions and responses. Ongoing professional interactions, such as those provided by academic detailing and telehealth coaching from specialists to PCPs offer potential to improve interprofessionality, Dr Boone said.
Boone J, Elder N, Short A, et al. Minimal versus intensive interprofessional quality improvement for chronic pain management in primary care. Abstract 266. . Presented at: APS 2016. May 11-14, 2016; Austin, Tx.