Improving pain care through implementation of the Stepped Care Model at a multisite community health center

Abstract

PurposeTreating pain in primary care is challenging. Primary care providers (PCPs) receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM) at a large, multisite Federally Qualified Health Center.MethodsThe Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention) cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence.ResultsProviders’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009). There was no significant change in opioid prescribing.ConclusionImplementation of the SCM-PM resulted in clinically significant improvements in several quality of pain care outcomes. These findings, if sustained, may translate into improved patient outcomes.

Mixed‐Methods Study Identifying Key Intervention Targets to Improve Participation in Daily Living Activities in Primary Sjögren's Syndrome Patients

“…Multidisciplinary education has been shown to empower rheumatoid arthritis patients to manage their condition and reduce disease activity in the longer term . We hypothesize that addressing these factors, for example through individualized interventions supporting patients to manage their oral and ocular dryness symptoms and with nonpharmacologic interventions such as exercise , pain management , and cognitive behavioral therapy for sleep disturbances , patients may feel more patient empowered. Modes of delivering these interventions need to be considered, and digital technologies, such as the use of mobile applications, can be used to empower patients to take charge of their own health and used as an adjunct to face‐to‐face care.…”

Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices

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“…While there have been some studies of opioid stewardship in primary care settings [11][12][13][14][15][16], most have been within one health care system and have not examined differences across systems and practices. Additionally, only a few of these studies examined implementation explicitly, which is a critical component of putting evidence-based interventions into practice.…”

Chronic Opioid Therapy: A Scoping Literature Review on Evolving Clinical and Scientific Definitions

“…Finally, a total of 227 reviewed studies meeting all inclusion criteria were identified in this scoping review (Fig 1). [2][3][4][5][6][33][34][35][36][37][38][39][40][41][42][45][46][47][48][49][51][52][53][54][55][56][57][58][59][60][63][64][65][66][67][68][69][70][71][72][73][103][104][105][106][107][108][109][110][111][113][114][115][116][117][118][119][120][121][122][123]…”