Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA.
Emory School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
J Gen Intern Med. 2022 May;37(6):1501-1512. doi: 10.1007/s11606-021-07255-w. Epub 2022 Mar 3.
Current pain management recommendations emphasize leveraging interdisciplinary teams. We aimed to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings.
We searched PubMed, EMBASE, and CINAHL for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (e.g., BPI total pain, GCPS pain intensity, RMDQ pain-related disability), include primary care as an intervention setting, and demonstrate some evidence of teamwork or teaming; specifically, they needed to involve at least two clinicians interacting with each other and with patients in an ongoing process over at least two timepoints. We assessed study quality with the Cochrane Risk of Bias tool. We narratively synthesized intervention team structures and processes, comparing among interventions that reported a clinically meaningful improvement in patient-reported pain outcomes defined by the minimal clinically important difference (MCID).
We included 13 total interventions in our review, of which eight reported a clinically meaningful improvement in at least one patient-reported pain outcome. No included studies had an overall high risk of bias. We identified the role of a care manager as a common structural feature of the interventions with some clinical effect on patient-reported pain. The team processes involving clinicians varied across interventions reporting clinically improved pain outcomes. However, when analyzing team processes involving patients, six of the interventions with some clinical effect on pain relied on pre-scheduled phone calls for continuous patient follow-up.
Our review suggests that interdisciplinary interventions incorporating teamwork and teaming can improve patient-reported pain outcomes in comparison to usual care. Given the current evidence, future interventions might prioritize care managers and mechanisms for patient follow-up to help bridge the gap between clinical guidelines and the implementation of interdisciplinary, team-based chronic pain care.
目前的疼痛管理建议强调利用跨学科团队。我们旨在确定与改善初级保健环境中慢性疼痛患者的疼痛结果相关的跨学科团队结构和流程的关键特征。
我们在 PubMed、EMBASE 和 CINAHL 中搜索了 2009 年后发表的随机研究。纳入的研究必须报告患者报告的疼痛结果（例如，BPI 总疼痛、GCPS 疼痛强度、RMDQ 疼痛相关残疾），将初级保健作为干预设置，并展示出一些团队合作或团队合作的证据；具体来说，他们需要至少有两名临床医生相互作用，并在至少两个时间点上与患者进行持续的互动。我们使用 Cochrane 偏倚风险工具评估研究质量。我们对干预团队结构和流程进行了叙述性综合，比较了报告患者报告的疼痛结果（由最小临床重要差异 (MCID) 定义）有临床意义改善的干预措施。
我们的综述共纳入了 13 项干预措施，其中 8 项报告了至少一项患者报告的疼痛结果有临床意义的改善。没有纳入的研究整体存在高偏倚风险。我们确定了护理经理的角色是具有临床效果的干预措施的共同结构特征，对患者报告的疼痛有影响。涉及临床医生的团队流程因报告具有临床改善疼痛结果的干预措施而异。然而，当分析涉及患者的团队流程时，六项具有临床效果的疼痛干预措施依赖于预先安排的电话进行持续的患者随访。
我们的综述表明，跨学科团队合作干预措施可以改善患者报告的疼痛结果，与常规护理相比。鉴于目前的证据，未来的干预措施可能会优先考虑护理经理和患者随访机制，以帮助弥合临床指南与跨学科、基于团队的慢性疼痛护理之间的差距。
