The Characteristics and Effectiveness of Interventions for Frequent Emergency Department Utilizing Patients With Chronic Noncancer Pain: A Systematic Review

Abstract

Background Patients with chronic noncancer pain (CNCP) present unique challenges to emergency department (ED) care providers and administrators. Their conditions lead to frequent ED visits for pain relief and symptom management and are often poorly addressed with costly, low‐yield care. A systematic review has not been performed to inform the management of frequent ED utilizing patients with CNCP. Therefore, we synthesized the available evidence on interventional strategies to improve care‐associated outcomes for this patient group. Methods We searched Medline, EMBASE, CINAHL, CENTRAL, SCOPUS, and Web of Science from database inception to June 2018 for eligible interventional studies aimed at reducing frequent ED utilization among adult patients with CNCP. Articles were assessed in duplicate in accordance with methodologic recommendations from the Cochrane Handbook for Systematic Reviews of Interventions. Outcomes of interest were the frequency of subsequent ED visits, type and amount of opioids administered in the ED and prescribed at discharge, and costs. Methodologic quality was assessed using the Cochrane Risk of Bias in Non‐Randomized Studies of Interventions and Risk of Bias tools for nonrandomized and randomized studies, respectively. Results Thirteen studies including 1,679 patients met the inclusion criteria. Identified interventions implemented pain policies (n = 4), individualized care plans (n = 5), ED care coordination (n = 2), chronic pain management pathways (n = 1), and behavioral health interventions (n = 1). All of the studies reported a decrease in ED visit frequency following their respective interventions. These reductions were especially pronounced in studies whose interventions were focused around individualized care plans and primary care involvement. Interventions implementing opioid restriction and pain management policies were largely successful in reducing the amounts of opioid medications administered and prescribed in the ED. Conclusions Multifaceted interventions, especially those employing individualized care plans, can successfully reduce subsequent ED visits, ED opioid administration and prescription, and care‐associated costs for frequent ED utilizing patients with CNCP.

Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel

“…We used four key publications selected by project staff to represent different aspects of care coordination research (clinical integration, implementation of technological advances, social network analysis of provider relationships and interpersonal relationships between providers) as seed articles for a forward search 1 2 6 7. We screened studies included in 127 systematic reviews on care coordination to obtain a broad range of care coordination approaches 3–5 8–131. The reviews addressed common chronic conditions managed in primary as well as specialty care, cancer care, palliative care, comorbidity and complexity, personnel specialising in care coordination, frameworks and strategies to promote coordination, technology supporting coordination, settings for temporary care such as emergency departments and care models applied to specific populations.…”

Exploring personalised care planning approaches for adults with long‐term conditions to inform future musculoskeletal care planning: A mixed‐methods systematic scoping review protocol

“…Care plans have been shown to reduce Emergency Department visits and Emergency Department opioid administration in patients with chronic non-cancer pain (Wong et al, 2020). Additionally, a seminal Cochrane review concluded that personalised care planning across different long-term health conditions leads to improvements in certain indicators of physical and psychological health, including blood glucose levels, depression, self-efficacy and self-care activities when compared to usual care (Coulter et al, 2015).…”

Intranasal Ketorolac for Acute Pain in Adult Emergency Department Patients

“…Pain is the number one reason for seeking emergency department (ED) care, accounting for up to 78% of ED visits (Hooker et al, 2019;Miner, 2019;Motov et al, 2017;Pourmand et al, 2018;Todd et al, 2007;Wong et al, 2020). For many reasons including the opioid epidemic with an exponential increase in individuals with opioid use disorder (OUD) in recent years and opioid side effects, an alternative analgesic is desirable (Daoust et al, 2020;Duber et al, 2018;Hatten et al, 2020;Kyriacou, 2017;Luo et al, 2021;Pollack et al, 2016;Pourmand et al, 2018).…”