Creation of a Multispecialty Clinic for Patients with Central Sensitization–Based Chronic Pain Conditions

Abstract

Objective To design and evaluate, through a human-centered design approach, a multispeciality clinic for patients with central sensitization syndromes that combined virtual previsit consultations, traditional face-to-face appointments, and technology-enabled educational programming. Patients and Methods Patients with suspected fibromyalgia and chronic abdominal pain were seen in a multispecialty practice, and the performance of the clinic was evaluated against a contemporary cohort. Quantitative and qualitative evaluation measures included team estimates of time spent on care-related tasks, physician rank of alignment of patient need with clinic design, major appointment changes, and nonvisit care tasks. Members of the care team also evaluated strengths, weaknesses, opportunities, and threats to the success of the clinic. Results The pilot clinic was operated from April 1, 2020, to April 30, 2021, and included 34 patients with suspected fibromyalgia/chronic abdominal pain. During the pilot period, physicians ranked the value of the virtual previsit consultations in providing care as 7.5 on a scale of 0 to 10 and reported an average of 50 minutes in preparation for the appointment, execution of the appointment, and postvisit documentation. We did not observe substantial differences in the number of added appointments or messages received within the patient portal when compared with a comparison cohort. Patients who participated in the combination nurse educator–led and digital education program provided positive feedback about their experience. Conclusion Our clinic model provides a framework for the treatment of patients with debilitating centrally sensitized conditions and future expansion of virtual care delivery models to better meet patient care and educational needs.

Co-Morbidities of Irritable Bowel Syndrome in a Racially and Ethnically Diverse Population

“…As demonstrated in a meta-analysis, IBS patients had significantly higher anxiety and depression levels than controls ( p < 0.01) [ 39 ]. Another study showed that both anxiety and depression were predictors of the development of IBS, and IBS patients without anxiety and depression at baseline reported higher levels of these conditions at follow-up [ 40 ].…”

Implementation of eLearning solutions for patients with chronic pain conditions

“… 2 We developed eLearning content based on pain neuroscience education programming created for patients with fibromyalgia, 20 and was created as an extension of the multidisciplinary clinical effort described previously. 21 Five mHealth eLearning courses were created by multidisciplinary teams to focus on five centrally sensitized-based chronic pain conditions: fibromyalgia, post-COVID syndrome, chronic fatigue, irritable bowel syndrome, and chronic migraine. The in-person, virtual, and traditional paper-based patient education materials were digitized to include videos by multi-specialty providers, 8 animations, pictures, and interactive content, which incorporated neurobiology-based education that has been shown to improve symptom severity, pain catastrophizing, depression and anxiety.…”

Digital Care Horizon: A Framework for Extending Health Care Through Digital Transformation

“…This information is used by allied health and nursing to arrange itineraries for on-site visits and to determine whether a patient may benefit from a virtual previsit. 3 Information is also requested regarding their social determinants of health. Our clinical teams use this information to understand the environment from which a patient arrives and to arrange for nonmedical services.…”

“… 4 Once an episode of care is completed on site, our care teams also digitally extend patient support into the postvisit space through nurse-led individual and group educational programming. 3 These models extend the “episode of care” beyond the face-to-face visit advancing understanding of patient need, increasing visit efficiency, and supporting the patient through their medical journeys.…”