Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA.
Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA.
Perm J. 2021 Oct 29;25:20.307. doi: 10.7812/TPP/20.307.
The complexity of chronic non-cancer pain in the setting of regulatory efforts to curb opioid usage presents a novel challenge for the medical community. Much of this burden falls on primary care clinics. We retrospectively quantified the reduction of opioid usage by patients in a multimodal, interdisciplinary, primary care clinic for chronic pain.
A multimodal, interdisciplinary, chronic pain clinic embedded in a large academic military family medicine clinic operated one-half day weekly to address referrals from within the clinic at large. Appointment times were longer than typical primary care appointments. The clinic was equipped with support staff, ancillary specialty providers, and non-pharmacologic complementary treatment resources. A retrospective cohort review was conducted on 78 patients referred to this clinic from March 1, 2015 (the inception date of the clinic) through December 31, 2015.
Fifty-four of 78 patients met inclusion criteria. Overall mean morphine equivalent daily dosing (MEDD) dropped from 31.5 MEDD to 20.5 MEDD (p = 0.0005) 12 months post-intervention and from 31.5 MEDD to 9.5 MEDD (p < 0.0001) 36 months post-intervention. Four patients with a high mean baseline opioid dose of 185.2 MEDD dropped to 29.9 MEDD 36 months post-intervention. The mean 0-10 pain score decreased from 5.3 ± 2.2 to 4.0 ± 2.5 (p = 0.001).
A multimodal, interdisciplinary, primary care-based, chronic pain clinic equipped with extended appointment times, non-pharmacologic treatment resources, and specialty access can curb opioid usage. Leadership support for protracted appointment duration, complementary treatment resources, and interdisciplinary personnel is crucial to success.
在控制阿片类药物使用的监管努力下，慢性非癌性疼痛的复杂性给医疗界带来了新的挑战。这些负担大多落在初级保健诊所身上。我们回顾性地量化了在一个多模式、跨学科的慢性疼痛初级保健诊所中患者的阿片类药物使用量减少情况。
一个多模式、跨学科的慢性疼痛诊所嵌入在一个大型学术军事家庭医学诊所中，每周运营半天，以满足整个诊所的转介需求。预约时间比典型的初级保健预约时间长。该诊所配备了支持人员、辅助专科医生和非药物补充治疗资源。对 2015 年 3 月 1 日（诊所成立日期）至 2015 年 12 月 31 日期间转诊到该诊所的 78 名患者进行了回顾性队列研究。
78 名患者中有 54 名符合纳入标准。干预后 12 个月，总体平均吗啡等效日剂量（MEDD）从 31.5 MEDD 降至 20.5 MEDD（p=0.0005），干预后 36 个月降至 9.5 MEDD（p<0.0001）。4 名基线阿片类药物剂量较高（平均 185.2 MEDD）的患者在干预后 36 个月降至 29.9 MEDD。0-10 疼痛评分从 5.3±2.2 降至 4.0±2.5（p=0.001）。
配备延长预约时间、非药物治疗资源和专科医生的多模式、跨学科、基于初级保健的慢性疼痛诊所可以减少阿片类药物的使用。对延长预约时间、补充治疗资源和跨学科人员的领导力支持对于成功至关重要。
