Communication between nurse care managers and patients who take opioids for chronic pain: Strategies for exploring aberrant behavior

2018 ◽  
Vol 14 (3) ◽  
pp. 191-202 ◽  
Author(s):  
Jane M. Liebschutz, MD, MPH ◽  
Allison V. Lange, MD ◽  
Orlaith D. Heymann, MA ◽  
Karen E. Lasser, MD, MPH ◽  
Pamela Corey, MSN, EdD, RN, CHSE ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Management Strategies ◽  
Primary Care Providers ◽  
Prescribing Patterns ◽  
Care Providers ◽  
Nurse Care ◽  
Care Managers ◽  
Monitoring Strategies ◽  
Field Notes

Objective: One approach to potential misuse of prescription opioids by patients with chronic pain is team-based collaborative primary care, with primary care visits complemented by frequent visits with nurse care managers (NCMs) specializing in addiction care. However, little is known about the communication strategies NCMs employ in these visits. This study aimed to describe strategies NCMs used with patients when discussing aberrancies encountered during opioid monitoring.Design: Observational study of NCM-patient interactions. Patients' primary care providers had been randomized to the treatment arm of a study evaluating an intervention, of which NCM visits were part, to change opioid prescribing patterns. The overall intervention was found to be successful.Setting: Four primary care settings.Participants: Two NCMs and 41 patients.Main outcome measure: Forty one interactions between two NCMs and 41 unique patients were directly observed, and the detailed field notes coded for strategies using conventional content analysis.Results: Five themes describing strategies that NCMs use to navigate aberrant patient behavior emerged: (1) NCM develops therapeutic relationship with patient; (2) NCM encourages adherence to monitoring strategies by contextualizing intensive opioid management for patient; (3) NCM inquires into discrepancies between patient's narrative and objective data to further understand aberrancy; (4) NCM assesses patient's medication use and pain to obtain more information about aberrancy and determine risk for opioid misuse; and (5) NCM educates patient and makes recommendations to guide appropriate medication use.Conclusions: These findings provide a potential model for the replication of intensive care management strategies utilizing NCMs in primary care.

Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers

2021 ◽  
Vol 17 (1) ◽  
pp. 39-54
Author(s):  
Josiah D. Strawser, MD ◽  
Lauren Block, MD, MPH
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Risk Reduction ◽  
New York State ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Objective: To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.Design: Mixed-methods study with survey collection and semistructured interviews.Setting: Multiple academic hospitals in New York.Participants: One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews. Interventions: Introduction of IStop.Main outcome measure(s): Change in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and co-management) as reported by primary care providers for patients with chronic pain.Results: After the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management co-management with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and co-management (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management.Conclusions: After the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.

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.

Comanagement and emergency room admissions in oncology practice.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 21-21
Author(s):  
Jennifer Nadine Slim ◽  
Michelle Marie Loch
Keyword(s):  
Primary Care ◽  
Chest Pain ◽  
Cancer Survivors ◽  
Emergency Room ◽  
Care Provider ◽  
Primary Care Provider ◽  
Management Strategies ◽  
Primary Care Providers ◽  
Care Providers ◽  
Admission Rates

21 Background: Cancer survivors face many challenges and encompass a multitude of specialties. These patients frequently utilize emergency room services with increased admission rates and, often, significant consequences on health care costs. National Hospital Ambulatory Medical Care Survey data from 2011 reports non-ischemic heart disease, chest pain and pneumonia as the most common emergency room discharge diagnoses for adults. We hypothesized that cancer survivors who continue care with primary providers require fewer emergency room based admissions. Our purpose in identifying these demographics was to allow for further consideration of specific interventions that might improve out patient based management. Methods: We considered ongoing primary care as those assigned to a primary care provider. We developed a memorandum of intention to identify patients at risk for over utilization of emergency room services. We gathered anonymous data about oncology patients seen in clinic from July 2014 to August 2015. We were able to determine how many emergency room based admissions were attributed to these patients as well as patients with and without primary care providers assigned in the EMR. We further attempted to identify those at higher risk taking into account co-morbid diagnoses. Results: 2,627 survivors were seen in clinic with 163 emergency room based admissions. 75% of these patients did not have a primary care provider identified in EPIC and account for 51% of the admissions. Only two patients had 3 or fewer co-morbid diagnoses. The most common co-morbid diagnoses among patients with emergency room based admission were abdominal pain, anemia, and chest pain. Conclusions: This data would suggest that co-management with primary care providers alone is not adequate for cancer survivors. While about half of the admissions were those without assigned primary care; the overall percentage of admission was higher from those assigned primary care providers. We suggest risk factors and management strategies are unique to survivors and require a focused multidisciplinary approach. Further study focused on interventions unique to cancer survivors are warranted.

(136) Beliefs about prescribing opioids for chronic pain: survey of primary care providers

2014 ◽  
Vol 15 (4) ◽  
pp. S10
Author(s):  
R. Jamison ◽  
K. Sheehan ◽  
M. Matthews ◽  
E. Scanlan ◽  
E. Ross
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Primary Care Providers ◽  
Care Providers

scholarly journals Primary Care Providers' Views on Chronic Pain Management Among High-Risk Patients in Safety Net Settings

Pain Medicine ◽  
2012 ◽  
Vol 13 (9) ◽  
pp. 1141-1148 ◽  
Author(s):  
Maya Vijayaraghavan ◽  
Joanne Penko ◽  
David Guzman ◽  
Christine Miaskowski ◽  
Margot B. Kushel
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
High Risk ◽  
Primary Care Providers ◽  
Safety Net ◽  
Chronic Pain Management ◽  
Care Providers ◽  
High Risk Patients ◽  
Risk Patients

Telementoring for improving primary care provider knowledge and competence in managing chronic pain: A randomised controlled trial

2018 ◽  
Vol 26 (1-2) ◽  
pp. 21-27 ◽  
Author(s):  
Linda H Eaton ◽  
Daniel S Godfrey ◽  
Dale J Langford ◽  
Tessa Rue ◽  
David J Tauben ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Controlled Trial ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Perceived Competence ◽  
Control Group ◽  
Care Providers ◽  
Knowledge And Attitudes ◽  
Randomised Controlled

Introduction Primary care providers are frequently unprepared to manage chronic pain adequately due in part to insufficient professional training. This study evaluated the effect of a telementoring intervention on knowledge and perceived competence related to chronic pain management. Methods The study design was a cluster randomised controlled trial. Primary care clinics that were part of the University of Washington Medicine Telehealth network were the unit of randomization. Primary care providers comprised the intervention group ( n = 23) and the control group ( n = 18). Providers in the intervention group attended telementoring sessions through the TelePain programme and presented patient cases at the beginning and end of their enrolled patients’ 12-week study period. TelePain sessions included a didactic presentation and telementoring for specific patient cases by a panel of pain specialists from the disciplines of pain medicine, internal medicine, anaesthesiology, rehabilitation medicine, psychiatry, addiction medicine, nursing and complementary and integrative pain management. Providers’ baseline and end-of-study knowledge and perceived competence in managing chronic pain were assessed by three questionnaires: Knowledge and Attitudes Survey Regarding Pain, the KnowPain-12 and the Perceived Competence Scale. Results Knowledge (Z = –0.34, p = 0.97 (Knowledge and Attitudes Survey Regarding Pain) and Z = 0.49, p = 0.62 (KnowPain-12)) and perceived competence (Z = –0.74, p = 0.46) did not increase for providers in the intervention group compared with providers in the control group. These providers attended on average 12.5 sessions (range 0–31) while participating in the study. Discussion Further research is recommended to establish the effectiveness of this telementoring intervention.

scholarly journals Opioid Use Among Rural Medicare Beneficiaries

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 335-335
Author(s):  
Yvonne Jonk ◽  
Heidi O'Connor ◽  
Karen Pearson ◽  
Zachariah Croll ◽  
John Gale
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Providers ◽  
Community Dwelling ◽  
Prescribing Patterns ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Opioid Prescription ◽  
Opioid Prescribing

Abstract This study examines differences in opioid prescribing rates among a nationally representative sample of Medicare beneficiaries across rural and urban areas, as well as among beneficiaries with chronic overlapping pain conditions (COPCs). We assess whether prescribing patterns exceed the Centers for Disease Control and Prevention guidelines for dose and duration, and identify socioeconomic and health risk factors associated with opioid prescribing using logistic regression analyses. Data were from the 2010-2017 Medicare Current Beneficiary Survey files. Rural-Urban Commuting Area codes were used to identify patients’ residential location. The Area Health Resource Files were used to identify market characteristics such as primary care and mental health shortage areas. With the exception of 2010, over years 2011-2017, higher percentages of community-dwelling rural beneficiaries received opioid prescriptions (21.8-25.4%) compared to their urban counterparts (19.1-23.7%). During the same time period, facility-dwelling rural beneficiaries were more likely to receive opioid prescriptions (39.8-47.2%) compared to their urban counterparts (28.8-35.0%). Higher percentages (18.8%) of the community dwelling population in rural had COPCs compared to urban (15.2%), and a higher percentage of rural beneficiaries with COPCs (31.4%) received an opioid prescription than their urban counterparts (22.2%). Previous research points to other factors contributing to a lack of alternatives to opioids for pain management in rural areas, including greater reliance on primary care providers, lack of access to chronic pain specialists and alternative therapies, and travel barriers. Improving the capacity of rural primary care to deal with COPCs and expanding access to specialists via telehealth warrants further attention from policymakers.

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