What Makes for a Positive Patient Experience in Chronic Pain Care? A Qualitative Evaluation of Factors Affecting Veteran Patient Satisfaction Across Two Individualized Pain Care Interventions in VA Primary Care.

BACKGROUND

Veterans are at high risk for pain-related disability, medication overdose, and opioid-related deaths. In response, Veterans Affairs (VA) healthcare systems are working to implement innovative, multimodal pain care. Recently, the Veterans' Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study compared two interventions that provide individualized pain care and opioid tapering-an interdisciplinary integrated pain team (IPT) and pharmacist collaborative management (PCM).

OBJECTIVE

Informed by VOICE qualitative interview data, this paper examines patient experiences with IPT and PCM and identifies factors that affected patient satisfaction across both interventions.

APPROACH

We conducted qualitative, semi-structured interviews with 63 veteran patients who participated in VOICE. The first set of interviews (n = 32) examined patients' experience with the VOICE interventions and solicited suggestions for improvement. The second set (n = 31) examined patients' experiences with telehealth in VOICE and inquired about changes to pain-care access and delivery associated with the COVID-19 pandemic. We used rapid analysis procedures to identify themes across both sets of interviews.

KEY RESULTS

Veterans enrolled in both VOICE interventions described how they learned to better live with and self-manage pain. Across interventions, key factors that facilitated a positive patient experience included the opportunity to develop a long-term relationship with the clinician or care team, meaningful patient involvement in treatment planning and decision-making, adequate variety and accessibility of options for treatment and self-management, and ease of communication and care coordination.

CONCLUSION

Although IPT and PCM are unique interventions with significant differences from one another, the fundamental factors that influenced patients' satisfaction were common to both interventions, including the opportunity to develop a therapeutic patient-clinician relationship, engagement in shared decision-making, adequate care access, and support for care coordination. These factors, which are relevant across different pain care interventions and contexts, should be key considerations as healthcare organizations design and implement pain care interventions.