Enhancing the Safe and Effective Management of Chronic Pain in Accountable Care Organization Primary Care Practices in Kentucky

2016 ◽  
Vol 32 (2) ◽  
pp. 178-185 ◽  
Author(s):  
Selam Wubu ◽  
Laura Lee Hall ◽  
Paula Straub ◽  
Matthew J. Bair ◽  
Jill A. Marsteller ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Organization ◽  
Chronic Pain Management ◽  
Accountable Care ◽  
Care Practices ◽  
Primary Care Practices

Chronic pain is a prevalent chronic condition with significant burden and economic impact in the United States. Chronic pain is particularly abundant in primary care, with an estimated 52% of chronic pain patients obtaining care from primary care physicians (PCPs). However, PCPs often lack adequate training and have limited time and resources to effectively manage chronic pain. Chronic pain management is complex in nature because of high co-occurrence of psychiatric disorders and other medical comorbidities in patients. This article describes a quality improvement initiative conducted by the American College of Physicians (ACP), in collaboration with the Kentucky ACP Chapter, and the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, to enhance chronic pain management in 8 primary care practices participating in Accountable Care Organizations in Kentucky, with a goal of enhancing the screening, diagnosis, and treatment of patients with chronic pain.

scholarly journals Understanding primary care-oncology relationships within a changing healthcare environment

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jennifer Tsui ◽  
Jenna Howard ◽  
Denalee O’Malley ◽  
William L. Miller ◽  
Shawna V. Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Transitions ◽  
Formal System ◽  
The United States ◽  
Comparative Case Study ◽  
Health Care Environment ◽  
Optimal Care ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment. Methods Through a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10–12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results Nine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond. Conclusions With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships.

scholarly journals Mobile Applications for Pain Management: Scoping Review (Preprint)

2018 ◽  
Author(s):  
Peng Zhao ◽  
Illhoi Yoo ◽  
Robert Lancey
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Primary Care Physicians ◽  
Chronic Pain Management ◽  
Inclusion Criteria ◽  
Pain Diary ◽  
App Development ◽  
Hipaa Compliance ◽  
Google Play

BACKGROUND Pain is the most common and distressing symptom for patients. 30% of adults in the Unit-ed States suffer from chronic pain. The total cost of pain is much higher than the total costs of heart disease, cancer, and diabetes. The lack of health informatics tools to support acute and chronic pain management contributes to the chronic pain and opioid abuse crises. OBJECTIVE The purpose of this study was to systematically appraise the content and functionality of mobile pain management apps. Apps reviewed in this study included a pain diary feature, and we searched for apps intended for clinical usage that support (1) cross-platform compatibility, (2) clinician access to graphical pain data visualization, (3) HIPAA compliance, and (4) the validated PEG (Pain Intensity, Enjoyment of life, General activity) survey tool for primary care physicians’ pain management. METHODS The Apple App Store and the Google Play Store were searched to identify pain management apps on 2/20/2018. The inclusion criteria were as follows: (1) that apps include a pain diary function allowing users to record pain episodes, (2) are available in either Apple App Store or Google Play Store, and (3) are available in the English language. We excluded apps if they were limited to only specific forms of pain or specific diseases. RESULTS A total of 36 apps met the inclusion criteria. Most of the apps served as pain diary tools to record the key characteristics of pain. The apps displayed many quality and usability is-sues, and showed a great deal of quality variation even in the pain apps that had been up-dated or released within a year. In addition, nearly 60% of the apps had not been updated for more than one year. The problem of not involving healthcare professionals in app development has not been resolved. Approximately 31% of apps including a pain diary function engaged clinicians in app development. Only 19% involved end-users in development and then only in an ad-hoc way. According to our search for pain management apps fulfilling our four requirements for clinical usage, we found the following: only one third of the apps supported the cross-platforms, none of the apps supported clinician access to graphical pain data visualization, none secured HIPAA compliance, and none endorsed the PEG tool for primary care physicians’ chronic pain management. CONCLUSIONS The 36 pain management apps were of widely varying quality. Most of them did not meet reasonable quality standards in terms of usability and security, and lacked clinician and end-user involvement in app development impacting the clinical utility of these apps. We could not find any pain apps suitable for clinical usage despite high demand from clinicians owing to the opioid crisis in the US.

scholarly journals Teaching Chronic Pain in the Family Medicine Residency

2018 ◽  
Vol 50 (1) ◽  
pp. 22-27
Author(s):  
Kimberly Zoberi ◽  
Kelly M. Everard
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Family Medicine ◽  
Pain Assessment ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Family Medicine Residency

Background and Objectives: Chronic pain is a significant condition affecting many Americans. Primary care physicians play an important role in chronic pain management, but many residents and physicians feel poorly prepared to manage it. Methods: Data were collected as part of the 2016 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey, which was sent electronically to 484 program directors in the United States. The authors sought to determine whether residency directors’ attitudes about treating chronic pain were associated with the amount of time devoted to teaching family medicine residents about chronic pain assessment, therapy (use of opioids, use adjuvant pain medications, use of other nonopioids, use of nonpharmacological treatments), and risk management (risk assessment, use of pain management contracts, informed consent when prescribing opioids, and urine drug monitoring). Attitudes were assessed by asking whether: (1) chronic pain is best managed by a primary care physician (PCP); (2) prescribing opioid medications is time consuming; (3) prescribing opioids is high-risk; (4) prescribing opioids contributes to opioid misuse; and (4) effective nonopioid treatments exist. An additional question assessed confidence in treating chronic pain. Results: The response rate was 53%. The average family medicine residency devotes about 33 hours to education about pain management topics including 5.4 hours on chronic pain assessment, 16.2 hours on therapy, and 11.4 hours on risk assessment. Residency directors’ belief that there are effective nonopioid treatments for chronic pain was the only attitude item that was associated with teaching about chronic pain. Conclusions: Residency directors’ attitudes do not predict the time devoted to teaching chronic pain in family medicine residencies.

scholarly journals Potential COVID-19 vaccination opportunities in primary care practices in the United States

2021 ◽  
Author(s):  
Sanjay Basu ◽  
Rebecca Weintraub ◽  
Ishani Ganguli ◽  
Russell Phillips ◽  
Robert Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Physicians ◽  
Medical Expenditure Panel Survey ◽  
Care Delivery ◽  
The United States ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Care Practices ◽  
Primary Care Practices

AbstractRapid, widespread COVID-19 vaccination is critical to pandemic mitigation and recovery. To help policymakers interested in further enhancing primary care delivery of COVID-19 vaccines, it is important to estimate the absolute number of vaccination opportunities, and identify how these opportunities may fall disproportionately among different communities given the unequal way that COVID-19 falls upon communities of color, low-income, and rural communities. To quantify the potential benefits of greater primary care engagement in vaccination efforts, we estimated the number of potential vaccination opportunities (PVOs) in primary care in the remaining calendar months of year 2021, and the possible uptake if we supplied enough vaccine to primary care practices to fulfill their opportunities. To estimate how many potential vaccination opportunities (PVOs) may occur in primary care, we used three sets of data, analyzing the latest available waves of the following: (i) the National Ambulatory Medical Care Survey (NAMCS, 2016, N = 677 providers); (ii) the National Health Interview Survey (NHIS, 2018, N = 29,839 individuals in 29,839 households); and (iii) the Medical Expenditure Panel Survey (MEPS, 2018, N = 40,025 individuals in 14,500 households). Per the NAMCS data, which provide a nationally-representative sample of ambulatory care visits, primary care physicians normally provide 40.2 million primary care visits per month. The majority of the primary care utilization is absorbed by those aged 16 to 64 years old who are not otherwise priority groups (i.e., not having chronic diseases as defined by ACIP) but the second large group of visits are those with a chronic disease (27.2% of all visits). As compared to the NAMCS data providing an estimate of care from the perspective of providers, the overall sample in NHIS provides a view of primary care access and utilization from a population perspective. Per NHIS, 34% of the civilian US population saw a generalist physician in the prior calendar year, or 109.8 million people. Overall, we would estimate that over the latter half of calendar year 2021, approximately 15 million potential vaccine opportunities per month would be available through US primary care practices.

Uninsured Children With Psychosocial Problems: Primary Care Management

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 930-936 ◽  
Author(s):  
Thomas K. McInerny ◽  
Peter G. Szilagyi ◽  
George E. Childs ◽  
Richard C. Wasserman ◽  
Kelly J. Kelleher
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Mental Health Problems ◽  
Psychosocial Problems ◽  
The United States ◽  
Behavior Study ◽  
Care Practices ◽  
Uninsured Children ◽  
Primary Care Practices

Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of psychosocial problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of psychosocial problems (19%) and severe psychosocial problems (2%). For children with a clinician-identified psychosocial problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified psychosocial and mental health problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.psychosocial problems, uninsured children, pediatrics, family medicine, primary care.

Identifying Teaming in Chronic Pain Management Interventions in Primary Care: A Systematic Review

2021 ◽  
Vol 2021 (1) ◽  
pp. 11391
Author(s):  
Karleen F. Giannitrapani ◽  
Natalie Connell ◽  
Pallavi Prathivadi ◽  
Sophia Zupanc ◽  
Hong-Nei Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Chronic Pain Management ◽  
Management Interventions

Tools, Time, Training, and Team—Military Primary Care Providers’ Perspectives on Improving Chronic Pain Assessment and Management

2021 ◽  
Author(s):  
Asha Mathew ◽  
Honor McQuinn ◽  
Diane M Flynn ◽  
Jeffrey C Ransom ◽  
Ardith Z Doorenbos
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Assessment ◽  
Insurance Coverage ◽  
Primary Care Providers ◽  
Stepped Care ◽  
Chronic Pain Management ◽  
Care Providers ◽  
Pain Care

ABSTRACT Introduction Primary care providers are on the front lines of chronic pain management, with many reporting frustration, low confidence, and dissatisfaction in handling the complex issues associated with chronic pain care. Given the importance of their role and reported inadequacies and dissatisfaction in managing this challenging population, it is important to understand the perspectives of primary care providers when considering approaches to chronic pain management. This qualitative descriptive study aimed to comprehensively summarize the provider challenges and suggestions to improve chronic pain care in military primary care settings. Materials and Methods Semi-structured interviews with 12 military primary care providers were conducted in a single U.S. Army medical center. All interviews were audio-recorded and lasted between 30 and 60 minutes. Interview transcripts were analyzed using ATLAS 9.0 software. Narratives were analyzed using a general inductive approach to content analysis. The Framework Method was used to organize the codes and emergent categories. All study procedures were approved by the Institutional Review Board of the University of Washington. Results Four categories captured providers’ challenges and suggestions for improving chronic pain care: (1) tools for comprehensive pain assessment and patient education, (2) time available for each chronic pain appointment, (3) provider training and education, and (4) team-based approach to chronic pain management. Providers suggested use of the Pain Assessment Screening Tool and Outcomes Registry, more time per visit, incorporation of chronic pain care in health sciences curriculum, consistent provider training across the board, insurance coverage for complementary and integrative therapies, patient education, and improved access to interdisciplinary chronic pain care. Conclusions Lack of standardized multifaceted tools, time constraints on chronic pain appointments, inadequate provider education, and limited access to complementary and integrative health therapies are significant provider challenges. Insurance coverage for complementary and integrative health therapies needs to be expanded. The Stepped Care Model of Pain Management is a positive and definite stride toward addressing many of these challenges. Future studies should examine the extent of improvement in guidelines-concordant chronic pain care, patient outcomes, and provider satisfaction following the implementation of the Stepped Care Model of Pain Management in military health settings.

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