TY - JOUR
T1 - Provision of recommended chronic pain assessment and management in primary care
T2 - Does Patient-Centered Medical Home (PCMH) recognition make a difference?
AU - Elder, Nancy
AU - Penm, Michelle
AU - Pallerla, Harini
AU - Meulen, Mary Beth Vonder
AU - Short, Amy Diane
AU - Diers, Tiffiny
AU - Imhoff, Ryan Joseph
AU - Wilson, Brendan
AU - Boone, Jill Martin
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background: Chronic pain (CP) care in the patient-centered medical home (PCMH) model has not been well studied. We assessed whether PCMH recognition is associated with increased provision of key practice recommendations for CP assessment and management. Methods: Chart reviews were completed for 12 primary care practices affiliated with one health system in the Cincinnati Area Research and Improvement Group (CARInG). Recommendations were abstracted and compared based on PCMH status: 3 practices had received prior PCMH level 3 recognition, 5 were in an ongoing process of applying, and 4 had no recognition and were not applying. Results: A total of 485 charts were reviewed from 65 PCPs. Eight of 10 key recommendations were documented more often in the prior and ongoing PCMH cohorts, including assessing pain severity, function, psychosocial distress, and substance abuse, and using structured instruments for these assessments. There were fewer differences between the cohorts in the management of chronic opioids, with only the ongoing PCMH cohort having higher documentation for 5 of the 7 recommendations, including performing urine drug screens and using a structured instrument to assess for misuse. Conclusions: These findings support the usefulness of the PCMH model in managing patients with CP, but patient outcomes need to be addressed in future studies.
AB - Background: Chronic pain (CP) care in the patient-centered medical home (PCMH) model has not been well studied. We assessed whether PCMH recognition is associated with increased provision of key practice recommendations for CP assessment and management. Methods: Chart reviews were completed for 12 primary care practices affiliated with one health system in the Cincinnati Area Research and Improvement Group (CARInG). Recommendations were abstracted and compared based on PCMH status: 3 practices had received prior PCMH level 3 recognition, 5 were in an ongoing process of applying, and 4 had no recognition and were not applying. Results: A total of 485 charts were reviewed from 65 PCPs. Eight of 10 key recommendations were documented more often in the prior and ongoing PCMH cohorts, including assessing pain severity, function, psychosocial distress, and substance abuse, and using structured instruments for these assessments. There were fewer differences between the cohorts in the management of chronic opioids, with only the ongoing PCMH cohort having higher documentation for 5 of the 7 recommendations, including performing urine drug screens and using a structured instrument to assess for misuse. Conclusions: These findings support the usefulness of the PCMH model in managing patients with CP, but patient outcomes need to be addressed in future studies.
KW - Arthralgia
KW - Chronic Disease
KW - Chronic Pain
KW - Documentation
KW - Empathy
KW - Humans
KW - Internship and Residency
KW - Musculoskeletal Pain
KW - Opioid Analgesics
KW - Patient-Centered Care
KW - Primary Health Care
KW - Substance-Related Disorders
UR - http://www.scopus.com/inward/record.url?scp=84978924747&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84978924747&partnerID=8YFLogxK
U2 - 10.3122/jabfm.2016.04.160037
DO - 10.3122/jabfm.2016.04.160037
M3 - Article
C2 - 27390379
AN - SCOPUS:84978924747
SN - 1557-2625
VL - 29
SP - 474
EP - 481
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
IS - 4
ER -