IMPROVE: Improving Management of Chronic Pain in Primary Care
Chronic non-terminal pain is common in the United States, and improvements are needed in primary care where most chronic pain is managed. Among the problems associated with chronic pain is the epidemic of prescription opioid misuse and overdose deaths. In 2009, a national panel of experts published consensus guidelines for opioid therapy of chronic pain. Consequently, the Mallinckrodt C.A.R.E.S. AllianceSM, sponsered by Mallimckrodt Pharmaceuticals, has developed a set of tools for clinicians to improve the effectiveness and safety of opioid prescribing that align with the 2009 guidelines. Research to date suggests that many primary care clinicians have not integrated the 2009 guidelines into their work; this Quality Improvement project seeks to address this issue.
The two-phase demonstration project was designed to refine and test implementation of chronic pain management tools currently used in primary care practice settings, with the broad goal of improving the safety and effectiveness of opioid prescribing for chronic non-terminal pain.
The specific aims:
- Review and refine opioid management tools, leading to the development of a practice-adaptable toolkit and an implementation guide
- Assess perspectives of patients and primary care clinicians regarding implementation of toolkit
- Evaluate the feasibility of primary care clinicians to collect and track patient-reported function during routine clinical visits
Phase 1 (complete) - Expert Panels: We recruited primary care clinicians, administrative staff and specialist consultants to provide guidance in the refinement of a subset of opioid management tools and in the development of an implementation guide. Panel outcomes will be a practice-adaptable toolkit and implementation guide.
Phase 2 (complete) - Practice Implementation: We recruited practices that identified a need to improve their current opioid prescribing and patient management, but had not yet implemented a process for doing so, or implemented one that is not working as planned. Practices that have implemented a successful opioid prescribing and management protocol were not a good fit for this study. Practices were requested to implement the management program that is being tested in this project.
We invited 10 practices to participate in the eight-month implementation phase. During months one and two, practices continued with usual care, while documenting any concerns and/or frustrations with current opioid management procedures. Patient-reported functional assessment data was collected during this time to guide subsequent treatment and track opioid prescribing tool implementation. Over the next three months, practices were asked to utilize the practice-adaptable toolkit and implementation guide with new and current patients. During the final three months, providers and patients were asked to complete de-identified questionnaires in a traditional practice-based research card study. Practices were also asked for guidance on improving the tools and implementation guide.
This project was conducted from March 1, 2013 through April 2015.
This project is complete.
- Family Medicine physicians and practices are interested in improving chronic pain care and are excited to use streamlined, EHR-ready, team care-oriented tools to support the delivery of “best care” medicine to patients with chronic pain.
- Practice-based activities indicate that the chronic pain tools could achieve desired outcomes. Patients did not report problems or concerns with the tools they were asked to complete, and practice staff could include the tools during routine visits with little disturbance to the practice’s workflow.
- Quantitative data collected via an e-survey from Family Medicine physicians provides a profile of attitudes, current practices and self-identified needs to support caring for patients with chronic pain.
- Qualitative data collected from interviews and focus groups reveals five important themes that characterize (and reinforced quantitative findings) current attitudes, practice patterns and opportunities for improving care to patients with chronic pain.
Access the fill Issue brief here(4 page PDF) to read the detailed results and project summary.
For additional information about this study, please contact:
Kim Kimminau, PhD
AAFP National Research Network
Robin Liston, MPH
Research Project Manager
AAFP National Research Network
This project was supported by a grant from Mallinckrodt C.A.R.E.S. AllianceSM.