Dataset Information

A Shared Medical Appointment on the Benefits and Risks of Opioids Is Associated With Improved Patient Confidence in Managing Chronic Pain.

ABSTRACT:

Objectives

To evaluate a shared medical appointment (SMA) on opioids in the treatment of chronic pain.

Research design

This prospective study was conducted at an ambulatory clinic within a health-care delivery system. The SMA is a single 90-minute encounter, led by a physician. We included adult patients who attended the SMA and completed an immediate pre-post survey. Survey items were measured on a scale from 0 (worst) to 5 (best). Mean differences in pre-post responses were assessed by a paired t test.

Results

A total of 130 patients were included in the analysis. Patients showed improvements in confidence in self-managing pain (+0.44; 95% confidence interval [CI]: 0.29-0.59; P < .001) and their providers' ability to help manage pain (+0.28; 95% CI: 0.14-0.43; P < .001). Most patients (81%) were very/extremely satisfied with the SMA.

Conclusions

An SMA on the benefits and risks of opioids was associated with prompt improvements in patients' confidence in self-managing pain and in their health-care providers' ability to help manage pain. Such confidence can lay the foundation for increased patient engagement and activation in pain management.

SUBMITTER: Romanelli RJ

PROVIDER: S-EPMC5593266 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Publications

A Shared Medical Appointment on the Benefits and Risks of Opioids Is Associated With Improved Patient Confidence in Managing Chronic Pain.

Romanelli Robert J RJ Dolginsky Marina M Byakina Yuliya Y Bronstein Deborah D Wilson Sandra S

Journal of patient experience 20170508 3

<h4>Objectives</h4>To evaluate a shared medical appointment (SMA) on opioids in the treatment of chronic pain.<h4>Research design</h4>This prospective study was conducted at an ambulatory clinic within a health-care delivery system. The SMA is a single 90-minute encounter, led by a physician. We included adult patients who attended the SMA and completed an immediate pre-post survey. Survey items were measured on a scale from 0 (worst) to 5 (best). Mean differences in pre-post responses were asse ...[more]

PMID: 28959720

Similar Datasets

Project description:BackgroundCurrent guideline-recommended monitoring of patients prescribed long-term opioid therapy (LTOT) for chronic pain will likely result in increased identification of behaviors of concern for misuse and addiction, but there is a dearth of empiric evidence about how these behaviors should be managed.ObjectiveTo establish expert consensus about treatment approaches for common and challenging concerning behaviors that arise among patients on LTOT.DesignWe used a Delphi approach, which allows for generation of consensus.ParticipantsParticipants were clinical experts in chronic pain and opioid prescribing recruited from professional societies and other expert groups.Main measuresThe Delphi process was conducted online, and consisted of an initial brainstorming round to identify common and challenging behaviors, a second round to identify management strategies for each behavior, and two rounds to establish consensus and explore disagreement/uncertainty.Key resultsForty-two participants completed round 1, 22 completed round 2, 30 completed round 3, and 28 completed round 4. Half of round 1 participants were female (52%), and the majority were white (83%). Most (71%) were physicians, and most participants practiced in academic primary (40%) or specialty care (19%).The most frequently cited common and challenging behaviors were missing appointments, taking opioids for symptoms other than pain, using more opioid medication than prescribed, asking for an increase in opioid dose, aggressive behavior, and alcohol and other substance use. Across behaviors, participants agreed that patient education and information gathering were important approaches. Participants also agreed that stopping opioids is not important initially, but if initial approaches do not work, tapering opioids and stopping opioids immediately may become important approaches.ConclusionsThis study presents clinical expert consensus on how to manage concerning behaviors among patients on LTOT. Future research is needed to investigate how implementing these management strategies would impact patient outcomes, practice and policy.

Project description:BackgroundCurrent literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues.MethodsQualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1.ResultsWe identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants' perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment.ConclusionsThese results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more satisfaction for patients and providers, and provide important input to policy makers.Trial registrationClinicalTrials.gov NCT01345409 , date of registration 28/4/2011.

Dataset Information

A Shared Medical Appointment on the Benefits and Risks of Opioids Is Associated With Improved Patient Confidence in Managing Chronic Pain.

Objectives

Research design

Results

Conclusions

Publications

A Shared Medical Appointment on the Benefits and Risks of Opioids Is Associated With Improved Patient Confidence in Managing Chronic Pain.

Similar Datasets

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