Campwala Zahabiya, Davis Gregory, Khazen Olga, Trowbridge Rachel, Nabage Melisande, Bagchi Rohan, Argoff Charles, Pilitsis Julie G
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States.
Department of Neurosurgery, Albany Medical Center, Albany, NY, United States.
Front Pain Res (Lausanne). 2021 Nov 22;2:775210. doi: 10.3389/fpain.2021.775210. eCollection 2021.
Approximately 100 million adults in the United States have chronic pain, though only a subset utilizes the vast majority of healthcare resources. Multidisciplinary care has been shown to improve outcomes in a variety of clinical conditions. There is concern that multidisciplinary care of chronic pain patients may overwhelm existing resources and increase healthcare utilization due to the volume of patients and the complexity of care. We report our findings on the use of multidisciplinary conferences (MDC) to facilitate care for the most complex patients seen at our tertiary center. Thirty-two of nearly 2,000 patients seen per year were discussed at the MDC, making up the top 2% of complex patients in our practice. We evaluated patients' numeric rating score (NRS) of pain, medication use, hospitalizations, emergency department visits, and visits to pain specialists prior to their enrollment in MDC and 1 year later. Matched samples were compared using Wilcoxon's signed rank test. Patients' NRS scores significantly decreased from 7.64 to 5.54 after inclusion in MDC ( < 0.001). A significant decrease in clinic visits ( < 0.001) and healthcare utilization ( < 0.05) was also observed. Opioid and non-opioid prescriptions did not change significantly ( = 0.43). 83% of providers agreed that MDC improved patient care. While previous studies have shown the effect of multi-disciplinary care, we show notable improvements with a team established around a once-a-month MDC.
在美国，约有1亿成年人患有慢性疼痛，不过只有一部分人消耗了绝大部分医疗资源。多学科护理已被证明能改善多种临床病症的治疗效果。有人担心，慢性疼痛患者的多学科护理可能会因患者数量和护理复杂性而使现有资源不堪重负，并增加医疗资源的利用。我们报告了关于利用多学科会议（MDC）为在我们三级医疗中心就诊的最复杂患者提供护理的研究结果。每年近2000名患者中有32名在MDC上进行了讨论，占我们诊所复杂患者的前2%。我们评估了患者在参加MDC之前和1年后的疼痛数字评分量表（NRS）、药物使用情况、住院次数、急诊就诊次数以及看疼痛专科医生的次数。使用Wilcoxon符号秩检验对匹配样本进行比较。纳入MDC后，患者的NRS评分从7.64显著降至5.54（<0.001）。还观察到门诊就诊次数（<0.001）和医疗资源利用情况（<0.05）显著减少。阿片类药物和非阿片类药物处方没有显著变化（=0.43）。83%的医疗服务提供者认为MDC改善了患者护理。虽然之前的研究已经表明了多学科护理的效果，但我们通过围绕每月一次的MDC建立的团队展示了显著的改善。
