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

Autor:	Giannitrapani KF; Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System Menlo Park Division, Menlo Park, California, USA karleen@stanford.edu.; Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA., Holliday JR; Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System Menlo Park Division, Menlo Park, California, USA., McCaa MD; Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System Menlo Park Division, Menlo Park, California, USA., Stockdale S; Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA., Bergman AA; Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA., Katz ML; Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA., Zulman DM; Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System Menlo Park Division, Menlo Park, California, USA.; Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA., Rubenstein LV; Rand Corporation, Santa Monica, California, USA., Chang ET; Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.; Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Jan 02; Vol. 14 (1), pp. e080748. Date of Electronic Publication: 2024 Jan 02.
DOI:	10.1136/bmjopen-2023-080748
Abstrakt:	Objective: Chronic 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. Design: Secondary observational analysis of quantitative and qualitative evaluation data from a multisite randomised PC-based IM programme for high-risk patients. Setting: Five integrated local Veterans Affairs (VA) healthcare systems within distinct VA administrative regions. Participants: Staff and high-risk PC patients in the VA. Intervention: A 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. Results: Most (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. Conclusions: Pain 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. Competing Interests: Competing interests: We have read and understand the BMJ policy on competing interest and all authors have completed the ICMJE COI disclosure form. To the best of our knowledge, all authors report no competing interests, financial or other, that exist, apart from one author who reported receiving personal fees from Behavioral Health Services, Inc, outside the submitted work. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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