Meeting high-risk patient pain care needs through intensive primary care: a secondary analysis

• Published in: BMJ open Vol. 14; no. 1; p. e080748
• Main Authors: Giannitrapani, Karleen F, Holliday, Jesse R, McCaa, Matthew D, Stockdale, Susan, Bergman, Alicia A, Katz, Marian L, Zulman, Donna M, Rubenstein, Lisa V, Chang, Evelyn T
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 02.01.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Chronic Pain; Chronic Pain - epidemiology; Chronic Pain - therapy; Communication; Delivery of Health Care; Electronic health records; Health services; Hospitalization; Humans; Intervention; Interviews; Medical records; Mental health; Opioids; Organisation of health services; Pain; PAIN MANAGEMENT; Patient Care; Patient-Centered Care; Patient-Centred Medicine; Patients; Perceptions; Physicians; Primary care; Psychologists; Risk; Social workers; Teams; United States - epidemiology; United States Department of Veterans Affairs; Veterans; United States; PAIN MANAGEMENT; Patient-Centered Care; Chronic Pain; Organisation of health services
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-080748

ObjectiveChronic pain disproportionately affects medically and psychosocially complex patients, many of whom are at high risk of hospitalisation. Pain prevalence among high-risk patients, however, is unknown, and pain is seldom a focus for improving high-risk patient outcomes. Our objective is to (1) evaluate pain frequency in a high-risk patient population and (2) identify intensive management (IM) programme features that patients and providers perceive as important for promoting patient-centred pain care within primary care (PC)-based IM.DesignSecondary observational analysis of quantitative and qualitative evaluation data from a multisite randomised PC-based IM programme for high-risk patients.SettingFive integrated local Veterans Affairs (VA) healthcare systems within distinct VA administrative regions.ParticipantsStaff and high-risk PC patients in the VA.InterventionA multisite randomised PC-based IM programme for high-risk patients.Outcome measures(a) Pain prevalence based on VA electronic administrative data and (b) transcripts of interviews with IM staff and patients that mentioned pain.ResultsMost (70%, 2593/3723) high-risk patients had at least moderate pain. Over one-third (38%, 40/104) of the interviewees mentioned pain or pain care. There were 89 pain-related comments addressing IM impacts on pain care within the 40 interview transcripts. Patient-identified themes were that IM improved communication and responsiveness to pain. PC provider-identified themes were that IM improved workload and access to expertise. IM team member-identified themes were that IM improved pain care coordination, facilitated non-opioid pain management options and mitigated provider compassion fatigue. No negative IM impacts on pain care were mentioned.ConclusionsPain is common among high-risk patients. Future IM evaluations should consider including a focus on pain and pain care, with attention to impacts on patients, PC providers and IM teams.