Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System Menlo Park Division, Menlo Park, California, USA
Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.
BMJ Open. 2024 Jan 2;14(1):e080748. doi: 10.1136/bmjopen-2023-080748.
Chronic pain disproportionately affects medically and psychosocially complex patients, many of whom are at high risk of hospitalisation. Pain prevalence among high-risk patients, however, is unknown, and pain is seldom a focus for improving high-risk patient outcomes. Our objective is to (1) evaluate pain frequency in a high-risk patient population and (2) identify intensive management (IM) programme features that patients and providers perceive as important for promoting patient-centred pain care within primary care (PC)-based IM.
Secondary observational analysis of quantitative and qualitative evaluation data from a multisite randomised PC-based IM programme for high-risk patients.
Five integrated local Veterans Affairs (VA) healthcare systems within distinct VA administrative regions.
Staff and high-risk PC patients in the VA.
A multisite randomised PC-based IM programme for high-risk patients.
(a) Pain prevalence based on VA electronic administrative data and (b) transcripts of interviews with IM staff and patients that mentioned pain.
Most (70%, 2593/3723) high-risk patients had at least moderate pain. Over one-third (38%, 40/104) of the interviewees mentioned pain or pain care. There were 89 pain-related comments addressing IM impacts on pain care within the 40 interview transcripts. Patient-identified themes were that IM improved communication and responsiveness to pain. PC provider-identified themes were that IM improved workload and access to expertise. IM team member-identified themes were that IM improved pain care coordination, facilitated non-opioid pain management options and mitigated provider compassion fatigue. No negative IM impacts on pain care were mentioned.
Pain is common among high-risk patients. Future IM evaluations should consider including a focus on pain and pain care, with attention to impacts on patients, PC providers and IM teams.
慢性疼痛在医学和心理社会方面都较为复杂的患者中发生率过高，其中许多患者有住院的高风险。然而，高危患者的疼痛发生率尚不清楚，而且疼痛很少成为改善高危患者预后的重点。我们的目的是：（1）评估高危患者人群中的疼痛频率；（2）确定强化管理（IM）计划中患者和提供者认为对于促进以初级保健（PC）为基础的 IM 中的以患者为中心的疼痛护理重要的特征。
对多站点随机 PC 为基础的高危患者 IM 计划的定量和定性评估数据进行二次观察性分析。
五个不同 VA 行政区域内的 VA 综合医疗保健系统。
VA 中的工作人员和高危 PC 患者。
针对高危患者的多站点随机 PC 为基础的 IM 计划。
大多数（70%，2593/3723）高危患者有至少中度疼痛。超过三分之一（38%，40/104）的受访者提到了疼痛或疼痛护理。在 40 份访谈记录中，有 89 条与疼痛相关的评论，涉及 IM 对疼痛护理的影响。患者确定的主题是 IM 改善了沟通和对疼痛的反应能力。PC 提供者确定的主题是 IM 改善了工作负荷和获得专业知识的机会。IM 团队成员确定的主题是 IM 改善了疼痛护理协调，促进了非阿片类药物疼痛管理选择，并减轻了提供者的同情心疲劳。没有提到 IM 对疼痛护理的负面影响。
疼痛在高危患者中很常见。未来的 IM 评估应考虑将重点放在疼痛和疼痛护理上，同时关注对患者、PC 提供者和 IM 团队的影响。
