Good days and bad days: Innovation in capturing data about the functional status of our patients

Daily temporal self-care responses to osteoarthritis symptoms by older African Americans and whites

Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most prevalent chronic conditions in the USA. Because there is no known cure for OA, treatment is directed towards the alleviation of pain, improving function, and limiting disability. The major burden of care falls on the individual, who tailors personal systems of care to alleviate troublesome symptoms. To date, little has been known about the temporal variations in self-care that older patients with OA develop, nor has it been known to what extent self-care patterns vary with ethnicity and disease severity. This patient-centered descriptive study was designed to demonstrate the self-care strategies used by older African Americans and whites to alleviate the symptoms of OA on a typical day and during specific segments of a typical day over the past 30 days. A sample of 551 older adults participated in in-depth interviews, and the authors clustered their responses into six categories. Findings showed that the frequency of particular behaviors varied by time of day, disease severity, and race. Overall, patterns of self-care behaviors were similar between African Americans and whites, but African Americans used them in different proportions than whites. This study contributes to our knowledge of the dynamic and changing nature of self-care actions even within a single day. By defining how self-care is used in one illness by two different ethnic groups, we may be able to design appropriate educational programs that are more culturally specific to better meet the needs of patients with OA.

Pilot Study of Pain and Coping Among Patients With Osteoarthritis

BACKGROUND AND OBJECTIVES

Few studies have examined patterns of pain and coping among patients with osteoarthritis (OA). This pilot study used a daily diary approach to examine pain and coping strategy use among white and nonwhite veterans with OA.

METHODS

Participants (23 white, 13 nonwhite; 89% male; mean age = 63 years) completed diaries of pain (10-cm visual analog scale) and coping (total, problem-focused, and emotion-focused) for 30 days. Analyses examined relationships of mean self-reported pain severity and variability with coping strategy use as well as racial differences in these associations.

RESULTS

The mean pain level (4.46 [scale of 0-10], standard deviation [SD] = 2.12) and mean within-subject pain variance (1.94, SD = 1.79) were similar between white and nonwhite participants. With respect to pain variability, 2 distinct subgroups were observed, with approximately half of participants reporting high variability and half reporting low variability. The mean total coping score (on a scale of 0-7) was 2.62 (SD = 1.77), with problem-focused strategies being used more often than emotion-focused. There were no significant associations between coping (total, problem-focused, and emotion-focused) and mean pain severity, but the direction of these relationships differed according to race.

CONCLUSION

Results of this pilot study showed considerable between-subject variability in pain and coping strategy use as well as some racial differences. Medical treatment and self-management approaches may be improved if they can be tailored according to patients' pain patterns and preferred coping strategies.

[Effectiveness of a pharmaceutical care unit for the control of severe chronic pain]

INTRODUCTION

The effectiveness of a pharmaceutical care unit was assessed within a staged program for non-malignant severe chronic pain control in a multidisciplinary pain management unit at Consorcio Hospital General Universitario, Valencia, Spain.

MATERIALS AND METHODS

One hundred and fifty patients with clinical indication for a major opioid were included in WHO's third analgesic rung by our medical team following careful triage. The pharmaceutical care unit, or phase II, monitored dosage titration for pain stabilization with absence of side effects, as well as the onset of subsequent chronic therapy.

RESULTS

Upon program completion 75% of patients had their pain under control, having required 22.7 days on average for opiate dose titration. Mean daily dose was 22.3 mg, and constipation was prophylactically managed from the start. Fifty-nine percent of patients received subsequent chronic therapy with fentanyl transdermal patches at 25 microg/h; 10% followed suit with oral morphine solution, and 6% with controlled-release morphine. Twenty-five percent of the remaining patients had relevant events during the therapy titration stage, which led to therapy discontinuation and discharge because of lack of therapeutic effectiveness. After 24 months 70% of patients were still on initial doses.

CONCLUSIONS

The effectiveness of our unit was demonstrated by the achievement of the program objectives.