A qualitative study of the barriers to chronic pain management in the ED

Wilsey, Barth; Fishman, Scott M.; Crandall, Margie; Casamalhuapa, Carlos; Bertakis, Klea D

doi:10.1016/j.ajem.2007.05.005

Cited by 46 publications

(45 citation statements)

References 26 publications

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“…In addition to the absence of related policies and practical guidelines, inadequate resources obstruct care continuity (Wilsey et al, 2008) as a critical element of primary nursing care. In Korea, the main reasons for limited resource access, such as community-based exercise programmes for older adults in PHCs, were related to insufficient budget, individual financial difficulty, high care cost, and inconvenient transportation services (Park et al, 2013).…”

Section: Organizational Barriersmentioning

confidence: 99%

“…Most previous studies examined barriers to chronic pain management in institutional settings such as hospitals and nursing homes (Gudmannsdottir & Halldorsdottir, 2009;Teh et al, 2009;Wilsey et al, 2008), and patients' perspectives (Austrian, Kerns, & Reid, 2005;Davis et al, 2002;Dima et al, 2013;Gudmannsdottir & Halldorsdottir, 2009;Lansbury, 2000;Park et al, 2013;Teh et al, 2009), rather than nurses' perspectives. There is an urgent need for more investigation of the barriers nurses perceive when caring for older adults with chronic pain in community settings (Dewar, 2006;Teh et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…In provider-related barriers, chronic pain knowledge deficits (Kaasalainen et al, 2010) and limited recommendations for future approaches (Park et al, 2013) are included. Organizational-related barriers involve inadequate policies (Kaasalainen et al, 2010), limited resources (Davis, Hiemenz, & White, 2002;Park et al, 2013), few practice guidelines (Smith & Torrance, 2011), and insufficient time and staffing (Wilsey, Fishman, Crandall, Casamalhuapa, & Bertakis, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Barriers to chronic pain management in community-dwelling low-income older adults: Home-visiting nurses’ perspectives

Park

2016

Collegian

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Section: Organizational Barriersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Barriers to chronic pain management in community-dwelling low-income older adults: Home-visiting nurses’ perspectives

Park

2016

Collegian

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“…In addition, the signs of chronic pain are not always easily definable. Given that ED visits can be brief encounters, coupled with the lack of access to medical records, it can be difficult for ED providers to adequately treat the patient's pain while limiting the opportunity for misuse [14]. The provider's demographics, training, and experience all contribute to the differences in how these patients are managed [4].…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis

et al. 2014

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Chronic pain is a common reason for emergency department (ED) visits. Our objective was to describe opioid prescribing practices of ED providers when treating patients with chronic pain. We retrospectively evaluated opioid prescriptions from EDs at two tertiary care military hospitals. We queried the outpatient record database to obtain a list of opioid medications prescribed and ICD-9 codes associated with visits for chronic pain. We collected provider type and gender, number of pills, opioid type, and refills. We compared the incidence with chi-square or Fisher's exact tests. Wilcoxon test was used for non-parametric continuous variables. Over 3 years, 28,103 visits generated an opioid prescription. One thousand three hundred twenty-two visits were associated with chronic pain, and 443 (33 %) visits were associated with an opioid prescription. Providers were 79 % physicians, 19 % physician assistants (PAs), 81 % male, and 69 % active duty military. Medications were 43 % oxycodone, 30 % hydrocodone, 9.5 % tramadol, 2.5 % codeine, and 15 % other. The number of pills was 20 [interquartile range (IQR) 15-30] (range 1-240), morphine equivalents (M.E.) per pill was 7.5 [7.5-7.5] (2.5-120) and total M.E. per prescription was 150 [112.5-270] (15-6000). Physicians were more likely to prescribe a non-opioid than PAs (77 vs 45 %, p< 0.0001). Civilian providers were more likely to prescribe an opioid than active duty providers (58 vs 42 %, p<0.0001). Providers prescribed a median of 20 pills per prescription and most commonly prescribed oxycodone. PAs were more likely to prescribe an opioid for chronic pain than physicians. Civilian providers were more likely to prescribe an opioid than active duty providers.

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“…[3][4][5] Repetitive ED users with early returns are often poorly managed within the ED. Case management involves the process of identifying the needs of an individual patient and implementing or identifying ways to meet them.…”

Section: Introductionmentioning

confidence: 99%

Dynamic Internet-Mediated Team-Based Case Management of High-Frequency Emergency Department Users

Cy¹,

Tc³

et al. 2014

Hong Kong Journal of Emergency Medicine

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Introduction:We assessed whether a strategy using dynamic, internet-mediated, team-based case management could reduce the number of subsequent emergency department (ED) visits by frequent ED users. Methods: Patients who attended the ED three or more times within 72 hours in June 2010 were identified. These cases were divided into the pain management or chronic disease group according to their chief complaint. Patients were assessed by expert panels, and initial care plans were developed and posted on an internal website. Thereafter, each emergency physician could follow or adjust the care plans dynamically via the internal website according to the patient's condition and use the website to communicate results. Care plans were revised by the team according to the patient's clinical situation as it changed. Patient ED visits over the subsequent six months were monitored. Results: Fourteen cases were enrolled in the study, seven in each group. The mean number of visits per patient per month in the pain management and chronic disease groups decreased from 14.9 to 5.79 (p=0.031) and 6.1 to 2.9 (p<0.001) visits per month after the intervention, respectively. The overall mean number of visits per patient per month decreased from 10.5 to 4.36 (p=0.004), a decrease of 6.14 visits (58.27%). Conclusions: Dynamic internet-mediated team-based case management may help to reduce subsequent visits in patients who frequently visit the ED. (Hong Kong j.emerg.med.

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A qualitative study of the barriers to chronic pain management in the ED

Cited by 46 publications

References 26 publications

Barriers to chronic pain management in community-dwelling low-income older adults: Home-visiting nurses’ perspectives

Barriers to chronic pain management in community-dwelling low-income older adults: Home-visiting nurses’ perspectives

Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis

Dynamic Internet-Mediated Team-Based Case Management of High-Frequency Emergency Department Users

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