TY - JOUR
T1 - Primary Care Clinician Adherence to Guidelines for the Management of Chronic Musculoskeletal Pain
T2 - Results from the Study of the Effectiveness of a Collaborative Approach to Pain
AU - Corson, Kathryn
AU - Doak, Melanie N.
AU - Denneson, Lauren
AU - Crutchfield, Megan
AU - Soleck, Geoffrey
AU - Dickinson, Kathryn C.
AU - Gerrity, Martha S.
AU - Dobscha, Steven K.
N1 - Funding Information:
The authors gratefully acknowledge the assistance of Jean O'Malley MPH for consultation on statistical analyses made possible through support from the Oregon Clinical and Translational Research Institute, grant number UL1RR024140 01 from the National Center for Research Resources. We also thank Kurt Kroenke MD and Mark Sullivan MD PhD who helped to refine our intervention and measurement approaches, and the VA Primary Care Division clinicians for their participation and support.
Funding Information:
The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service Projects PMI 03–195 and RCD04129. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
PY - 2011/10
Y1 - 2011/10
N2 - Objective. We assessed primary care clinician-provided guideline-concordant care as documented in patients' medical records, predictors of documented guideline-concordant care, and its association with pain-related functioning. Patients were participants in a randomized trial of collaborative care for chronic musculoskeletal pain. The intervention featured patient and primary care clinician education, symptom monitoring and feedback to clinicians by the intervention team. Methods. To assess concordance with the evidence-based treatment guidelines upon which our intervention was based, we developed an 8-item chart review tool, the Pain Process Checklist (PPC). We then reviewed electronic medical records for 365 veteran patients treated by 42 primary care clinicians over 12 months. Intervention status, demographic, and clinical variables were tested as predictors of PPC scores using generalized estimating equations (GEE). GEE was also used to test whether PPC scores predicted treatment response (≥30% decrease in Roland-Morris Disability Questionnaire score). Results. Rates of documented guideline-concordant care varied widely among PPC items, from 94% of patients having pain addressed to 17% of patients on opioids having side effects addressed. Intervention status was unrelated to item scores, and PPC-7 totals did not differ significantly between intervention and treatment-as-usual patients (61.2%, standard error [SE]=3.3% vs 55.2%, SE=2.6%, P=0.15). In a multivariate model, higher PPC-7 scores were associated with receiving a prescription for opioids (odds ratio [OR]=1.07, P=0.007) and lower PPC-7 scores with patient age (10-year difference OR=0.97, P=0.004). Finally, intervention patients who received quantitative pain and depression assessments were less likely to respond to treatment (assessed vs not: 18% vs 33%, P=0.008, and 13% vs 28%, P=0.001, respectively). Conclusions. As measured by medical record review, additional training and clinician feedback did not increase provision of documented guideline-concordant pain care, and adherence to guidelines by primary care clinicians did not improve clinical outcomes for patients with chronic musculoskeletal pain. Wiley Periodicals, Inc.
AB - Objective. We assessed primary care clinician-provided guideline-concordant care as documented in patients' medical records, predictors of documented guideline-concordant care, and its association with pain-related functioning. Patients were participants in a randomized trial of collaborative care for chronic musculoskeletal pain. The intervention featured patient and primary care clinician education, symptom monitoring and feedback to clinicians by the intervention team. Methods. To assess concordance with the evidence-based treatment guidelines upon which our intervention was based, we developed an 8-item chart review tool, the Pain Process Checklist (PPC). We then reviewed electronic medical records for 365 veteran patients treated by 42 primary care clinicians over 12 months. Intervention status, demographic, and clinical variables were tested as predictors of PPC scores using generalized estimating equations (GEE). GEE was also used to test whether PPC scores predicted treatment response (≥30% decrease in Roland-Morris Disability Questionnaire score). Results. Rates of documented guideline-concordant care varied widely among PPC items, from 94% of patients having pain addressed to 17% of patients on opioids having side effects addressed. Intervention status was unrelated to item scores, and PPC-7 totals did not differ significantly between intervention and treatment-as-usual patients (61.2%, standard error [SE]=3.3% vs 55.2%, SE=2.6%, P=0.15). In a multivariate model, higher PPC-7 scores were associated with receiving a prescription for opioids (odds ratio [OR]=1.07, P=0.007) and lower PPC-7 scores with patient age (10-year difference OR=0.97, P=0.004). Finally, intervention patients who received quantitative pain and depression assessments were less likely to respond to treatment (assessed vs not: 18% vs 33%, P=0.008, and 13% vs 28%, P=0.001, respectively). Conclusions. As measured by medical record review, additional training and clinician feedback did not increase provision of documented guideline-concordant pain care, and adherence to guidelines by primary care clinicians did not improve clinical outcomes for patients with chronic musculoskeletal pain. Wiley Periodicals, Inc.
KW - Chronic Pain
KW - Pain Management
KW - Quality of Healthcare
KW - Randomized Controlled Trial
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U2 - 10.1111/j.1526-4637.2011.01231.x
DO - 10.1111/j.1526-4637.2011.01231.x
M3 - Article
C2 - 21943325
AN - SCOPUS:80255138295
SN - 1526-2375
VL - 12
SP - 1490
EP - 1501
JO - Pain Medicine
JF - Pain Medicine
IS - 10
ER -