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Will KK, Liang Y, Chi CL, Lamb G, Todd M, Delaney C. Measuring the Impact of Primary Care Team Composition on Patient Activation Utilizing Electronic Health Record Big Data Analytics. J Patient Cent Res Rev 2024; 11:18-28. [PMID: 38596347 PMCID: PMC11000700 DOI: 10.17294/2330-0698.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose Team-based care has been linked to key outcomes associated with the Quadruple Aim and a key driver of high-value patient-centered care. Use of the electronic health record (EHR) and machine learning have significant potential to overcome previous barriers to studying the impact of teams, including delays in accessing data to improve teamwork and optimize patient outcomes. Methods This study utilized a large EHR dataset (n=316,542) from an urban health system to explore the relationship between team composition and patient activation, a key driver of patient engagement. Teams were operationalized using consensus definitions of teamwork from the literature. Patient activation was measured using the Patient Activation Measure (PAM). Results from multilevel regression analyses were compared to machine learning analyses using multinomial logistic regression to calculate propensity scores for the effect of team composition on PAM scores. Under the machine learning approach, a causal inference model with generalized overlap weighting was used to calculate the average treatment effect of teamwork. Results Seventeen different team types were observed in the data from the analyzed sample (n=12,448). Team sizes ranged from 2 to 5 members. After controlling for confounding variables in both analyses, more diverse, multidisciplinary teams (team size of 4 or more) were observed to have improved patient activation scores. Conclusions This is the first study to explore the relationship between team composition and patient activation using the EHR and big data analytics. Implications for further research using EHR data and machine learning to study teams and other patient-centered care are promising and could be used to advance team science.
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Affiliation(s)
| | - Yue Liang
- University of Minnesota, Minneapolis, MN
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2
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Farrell SF, Edmunds D, Fletcher J, Martine H, Mohamed H, Liimatainen J, Sterling M. Effectiveness of psychological interventions delivered by physiotherapists in the management of neck pain: a systematic review with meta-analysis. Pain Rep 2023; 8:e1076. [PMID: 37731474 PMCID: PMC10508403 DOI: 10.1097/pr9.0000000000001076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 02/25/2023] [Indexed: 09/22/2023] Open
Abstract
Physiotherapists are increasingly using psychological treatments for musculoskeletal conditions. We assessed the effects of physiotherapist-delivered psychological interventions on pain, disability, and quality of life in neck pain. We evaluated quality of intervention reporting. We searched databases for randomized controlled trials (RCTs) comprising individuals with acute or chronic whiplash-associated disorder (WAD) or nontraumatic neck pain (NTNP), comparing physiotherapist-delivered psychological interventions to standard care or no treatment. Data were extracted regarding study characteristics and outcomes. Standardised mean difference (SMD) was calculated by random-effects meta-analysis. We evaluated certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and intervention reporting using TIDieR. Fourteen RCTs (18 articles-4 detail additional outcome/follow-up data) were included comprising 2028 patients, examining acute WAD (n = 4), subacute/mixed NTNP (n = 3), chronic WAD (n = 2), and chronic NTNP (n = 5). Treatment effects on pain favoured psychological interventions in chronic NTNP at short-term (SMD -0.40 [95% CI -0.73, -0.07]), medium-term (SMD -0.29 [95% CI -0.57, 0.00]), and long-term (SMD -0.32 [95% CI -0.60, -0.05]) follow-up. For disability, effects favoured psychological interventions in acute WAD at short-term follow-up (SMD -0.39 [95% CI -0.72, -0.07]) and chronic NTNP at short-term (SMD -0.53 [95% CI -0.91, -0.15]), medium-term (SMD -0.49 [95% CI -0.77, -0.21]), and long-term (SMD -0.60 [95% CI -0.94, -0.26]) follow-up. GRADE ratings were typically moderate, and intervention reporting often lacked provision of trial materials and procedural descriptions. Psychological interventions delivered by physiotherapists were more effective than standard physiotherapy for chronic NTNP (small-to-medium effects) and, in the short term, acute WAD.
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Affiliation(s)
- Scott F. Farrell
- RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Devon Edmunds
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - John Fletcher
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Harry Martine
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Hashem Mohamed
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Jenna Liimatainen
- RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
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3
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Chronic, Noncancer Pain Care in the Veterans Administration. Anesthesiol Clin 2023; 41:519-529. [DOI: 10.1016/j.anclin.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Effectiveness of a Primary Care Multidisciplinary Treatment for Patients with Chronic Pain Compared with Treatment as Usual. J Clin Med 2023; 12:jcm12030885. [PMID: 36769533 PMCID: PMC9918146 DOI: 10.3390/jcm12030885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
To manage chronic pain, multidisciplinary interventions have been increasingly deployed, mostly in secondary or tertiary care settings. Evidence on the effectiveness of multidisciplinary intervention within primary care is scarce. This study examined the effectiveness of a primary care multidisciplinary treatment for chronic pain compared with treatment as usual (TAU). The intervention consisted of pain neuroscience education and treatment by a GP, psychologist, and physiotherapist. Both groups filled out patient-reported outcome measures at baseline, 6 months, and 12 months. The results indicated there were no statistically significant differences for the primary outcomes of pain intensity, number of pain sites, and health-related quality of life (HR-QoL). There was a statistically significant difference in the secondary outcome perceived health change in favor of the intervention group. None of the other differences were statistically significant. A post-hoc analysis showed that there were statistically significant effects on patients' illness perceptions in favor of the intervention group. Based on the results, the findings do not support effectiveness of a low intensity outpatient multidisciplinary primary care treatment to treat chronic pain compared with TAU. However, as a result of several study limitations, it is considered unwarranted to conclude that multidisciplinary treatment in primary care is not valuable at all.
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Eklund K, Stålnacke BM, Sundberg A, Eklund F, Eklund M. INTRODUCTION OF A MULTIMODAL PAIN REHABILITATION INTERVENTION IN PRIMARY CARE: A PILOT STUDY. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2023; 6:3712. [PMID: 36875170 PMCID: PMC9983332 DOI: 10.2340/jrmcc.v6.3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 03/03/2023]
Abstract
Objective To evaluate patient-reported outcome measures in patients with chronic musculoskeletal pain 1 year after participation in a case manager-led multimodal rehabilitation intervention in a Finnish primary care centre. Changes in healthcare utilization (HCU) were also explored. Methods A prospective pilot study with 36 participants. The intervention consisted of screening, multidisciplinary team assessment, a rehabilitation plan and case manager follow-up. Data were collected through questionnaires filled in after the team assessment and 1 year later. HCU data 1 year before and 1 year after team assessment were compared. Results At follow-up, satisfaction with vocational situation, self-reported work ability and health-related quality of life (HRQoL) had improved and pain intensity had diminished significantly for all participants. The participants who reduced their HCU improved their activity level and HRQoL. Early intervention by a psychologist and mental health nurse was distinctive for the participants who reduced HCU at follow-up. Conclusion The findings demonstrate the importance of early biopsychosocial management of patients with chronic pain in primary care. Identification of psychological risk factors at an early stage may lead to better psychosocial wellbeing, improve coping strategy and reduce HCU. A case manager may free up other resources and thereby contribute to cost savings.
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Affiliation(s)
- Katarina Eklund
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Annica Sundberg
- Department of Social Services and Health Care in Jakobstad, The Rehabilitation Unit, Jakobstad, Finland
| | | | - Michael Eklund
- Department of Social Services and Health Care in Jakobstad, The Rehabilitation Unit, Jakobstad, Finland
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6
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The biopsychosocial model of pain 40 years on: time for a reappraisal? Pain 2022; 163:S3-S14. [DOI: 10.1097/j.pain.0000000000002654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
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Teaming in Interdisciplinary Chronic Pain Management Interventions in Primary Care: a Systematic Review of Randomized Controlled Trials. J Gen Intern Med 2022; 37:1501-1512. [PMID: 35239110 PMCID: PMC9086072 DOI: 10.1007/s11606-021-07255-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/28/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Current pain management recommendations emphasize leveraging interdisciplinary teams. We aimed to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings. METHODS We searched PubMed, EMBASE, and CINAHL for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (e.g., BPI total pain, GCPS pain intensity, RMDQ pain-related disability), include primary care as an intervention setting, and demonstrate some evidence of teamwork or teaming; specifically, they needed to involve at least two clinicians interacting with each other and with patients in an ongoing process over at least two timepoints. We assessed study quality with the Cochrane Risk of Bias tool. We narratively synthesized intervention team structures and processes, comparing among interventions that reported a clinically meaningful improvement in patient-reported pain outcomes defined by the minimal clinically important difference (MCID). RESULTS We included 13 total interventions in our review, of which eight reported a clinically meaningful improvement in at least one patient-reported pain outcome. No included studies had an overall high risk of bias. We identified the role of a care manager as a common structural feature of the interventions with some clinical effect on patient-reported pain. The team processes involving clinicians varied across interventions reporting clinically improved pain outcomes. However, when analyzing team processes involving patients, six of the interventions with some clinical effect on pain relied on pre-scheduled phone calls for continuous patient follow-up. DISCUSSION Our review suggests that interdisciplinary interventions incorporating teamwork and teaming can improve patient-reported pain outcomes in comparison to usual care. Given the current evidence, future interventions might prioritize care managers and mechanisms for patient follow-up to help bridge the gap between clinical guidelines and the implementation of interdisciplinary, team-based chronic pain care.
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8
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Pilitsis JG, Khazen O, Wenzel NG. Multidisciplinary Firms and the Treatment of Chronic Pain: A Case Study of Low Back Pain. FRONTIERS IN PAIN RESEARCH 2022; 2:781433. [PMID: 35295487 PMCID: PMC8915644 DOI: 10.3389/fpain.2021.781433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022] Open
Abstract
Sixteen million people suffer with chronic low back pain and related healthcare expenditures can be as high as $USD 635 billion. Current pain treatments help a significant number of acute pain patients, allowing them to obtain various treatments and then “exit the market for pain services” quickly. However, chronic patients remain in pain and need multiple, varying treatments over time. Often, a single pain provider does not oversee their care. Here, we analyze the current pain market and suggest ways to establish a new treatment paradigm. We posit that more cost effective treatment and better pain relief can be achieved with multi-disciplinary care with a provider team overseeing care.
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Affiliation(s)
- Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States.,Department of Neuroscience and Experimental Therapeutics, Albany, NY, United States
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany, NY, United States
| | - Nikolai G Wenzel
- Broadwell College of Business and Economics, Fayetteville State University, Fayetteville, NC, United States
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DeBar L, Mayhew M, Benes L, Bonifay A, Deyo RA, Elder CR, Keefe FJ, Leo MC, McMullen C, Owen-Smith A, Smith DH, Trinacty CM, Vollmer WM. A Primary Care-Based Cognitive Behavioral Therapy Intervention for Long-Term Opioid Users With Chronic Pain : A Randomized Pragmatic Trial. Ann Intern Med 2022; 175:46-55. [PMID: 34724405 PMCID: PMC9802183 DOI: 10.7326/m21-1436] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic pain is common, disabling, and costly. Few clinical trials have examined cognitive behavioral therapy (CBT) interventions embedded in primary care settings to improve chronic pain among those receiving long-term opioid therapy. OBJECTIVE To determine the effectiveness of a group-based CBT intervention for chronic pain. DESIGN Pragmatic, cluster randomized controlled trial. (ClinicalTrials.gov: NCT02113592). SETTING Kaiser Permanente health care systems in Georgia, Hawaii, and the Northwest. PARTICIPANTS Adults (aged ≥18 years) with mixed chronic pain conditions receiving long-term opioid therapy. INTERVENTION A CBT intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team (behaviorist, nurse, physical therapist, and pharmacist) versus usual care. MEASUREMENTS Self-reported pain impact (primary outcome, as measured by the PEGS scale [pain intensity and interference with enjoyment of life, general activity, and sleep]) was assessed quarterly over 12 months. Pain-related disability, satisfaction with care, and opioid and benzodiazepine use based on electronic health care data were secondary outcomes. RESULTS A total of 850 patients participated, representing 106 clusters of primary care providers (mean age, 60.3 years; 67.4% women); 816 (96.0%) completed follow-up assessments. Intervention patients sustained larger reductions on all self-reported outcomes from baseline to 12-month follow-up; the change in PEGS score was -0.434 point (95% CI, -0.690 to -0.178 point) for pain impact, and the change in pain-related disability was -0.060 point (CI, -0.084 to -0.035 point). At 6 months, intervention patients reported higher satisfaction with primary care (difference, 0.230 point [CI, 0.053 to 0.406 point]) and pain services (difference, 0.336 point [CI, 0.129 to 0.543 point]). Benzodiazepine use decreased more in the intervention group (absolute risk difference, -0.055 [CI, -0.099 to -0.011]), but opioid use did not differ significantly between groups. LIMITATION The inclusion of only patients with insurance in large integrated health care systems limited generalizability, and the clinical effect of change in scores is unclear. CONCLUSION Primary care-based CBT, using frontline clinicians, produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care but did not reduce use of opioid medication. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Lynn DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.D.)
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Lindsay Benes
- Kaiser Permanente Center for Health Research, Portland, Oregon, and Montana State University College of Nursing, Missoula, Montana (L.B.)
| | - Allison Bonifay
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Richard A Deyo
- Oregon Health & Science University School of Medicine, Portland, Oregon (R.A.D.)
| | - Charles R Elder
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Francis J Keefe
- Duke University School of Medicine, Durham, North Carolina (F.J.K.)
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Ashli Owen-Smith
- Georgia State University School of Public Health and Kaiser Permanente Center for Clinical and Outcomes Research, Atlanta, Georgia (A.O.)
| | - David H Smith
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | | | - William M Vollmer
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
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Miki T, Kondo Y, Kurakata H, Takebayashi T, Samukawa M. Effects of a physiotherapist-led approach based on a biopsychosocial model for spinal disorders: protocol for a systematic review. BMJ Open 2021; 11:e055144. [PMID: 34588269 PMCID: PMC8479989 DOI: 10.1136/bmjopen-2021-055144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Low back pain and neck pain are among the most common musculoskeletal disorders, and their related medical costs are rising every year. Many interventions are based on the biopsychosocial (BPS) model since the cause of pain is more multifaceted. Physiotherapists have increased opportunities to perform multidisciplinary interventions alone in clinical practice due to a lack of understanding of the model and its cost. Therefore, physiotherapist-led interventions using the BPS model are important and require an updated report summarising their effectiveness. Thus, the purpose of this study will be to summarise and synthesise the effects of physiotherapist-led interventions using the BPS model for spinal disorders. METHODS AND ANALYSIS We will search the Web of Science, CENTRAL, MEDLINE, PsycINFO, CINAHL and PEDro electronic databases, using a date range from inception to September 2021. We will include only randomised controlled trials for patients diagnosed with spinal disorders who received physiotherapist-led interventions based on the BPS model. The search will be limited to English-language publications. Pain intensity and disability are the primary outcomes. Secondary outcomes are any psychological factors. We will examine the short-term, medium-term and long-term effects, and a subgroup analysis will be conducted, if possible, to investigate the role of additional physiotherapist training. ETHICS AND DISSEMINATION This study is exempt from ethical approval because it involves publicly available documents. The findings will be submitted for publication in a relevant peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021258071.
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Affiliation(s)
- Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Hokkaido, Japan
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Kurakata
- Yumenomachi Home Nursing Care and Rehabilitation Service, Chiba, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Hokkido, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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Accounting for quality improvement during the conduct of embedded pragmatic clinical trials within healthcare systems: NIH Collaboratory case studies. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 8 Suppl 1:100432. [PMID: 34175091 PMCID: PMC8900087 DOI: 10.1016/j.hjdsi.2020.100432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/23/2020] [Accepted: 05/14/2020] [Indexed: 11/21/2022]
Abstract
Embedded pragmatic clinical trials (ePCTs) and quality improvement (QI) activities often occur simultaneously within healthcare systems (HCSs). Embedded PCTs within HCSs are conducted to test interventions and provide evidence that may impact public health, health system operations, and quality of care. They are larger and more broadly generalizable than QI initiatives, and may generate what is considered high-quality evidence for potential use in care and clinical practice guidelines. QI initiatives often co-occur with ePCTs and address the same high-impact health questions, and this co-occurrence may dilute or confound the ability to detect change as a result of the ePCT intervention. During the design, pilot, and conduct phases of the large-scale NIH Collaboratory Demonstration ePCTs, many QI initiatives occurred at the same time within the HCSs. Although the challenges varied across the projects, some common, generalizable strategies and solutions emerged, and we share these as case studies.
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Lee J. Influences of exercise interventions on overweight and obesity in children and adolescents. Public Health Nurs 2021; 38:502-516. [PMID: 33569831 DOI: 10.1111/phn.12862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/06/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Conflicting findings of the effects of exercise on body fat, free fat mass, insulin, insulin resistance, and physical fitness for overweight and obesity in children and adolescents. The purpose of this meta-analysis was to investigate the effects of exercise interventions in children and adolescents with overweight and obesity depending on exercise type and to build effective exercise interventions to reduce risks of metabolic disorders. METHODS Databases were used to find eligible studies regarding the effects of exercise interventions on overweight and obesity in children and adolescents in randomized controlled trails. Effect size was calculated using the standardized mean difference statistic and heterogeneity across studies was estimated using the Q statistic. RESULTS A total of 27 studies met the inclusion criteria. Children and adolescents with overweight and obesity who participated in aerobic exercise had reduced body mass index, % body fat, fasting insulin, free fat mass, TNF-α, and IL-6, and increased physical fitness compared with control groups. Reduced free fat mass in resistance exercise was not found. Glucose, insulin resistance, blood pressure, C-reactive protein (CRP), and blood markers including total cholesterol (TC), triglyceride, LDL, and HDL did not have significant change. Average exercise interventions were aerobic exercise, 3 times/week, 60 min, and 36 weeks of exercise period. CONCLUSIONS Aerobic exercise may be beneficial to reduce body fat, fasting insulin, and inflammatory markers, and increased physical fitness for overweight and obesity in childhood and adolescence, but resistance exercise may be added, which can help avoid muscle loss in children and adolescents with overweight and obesity.
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Affiliation(s)
- Junga Lee
- Sports Medicine and Science, KyungHee University, Global Campus, Republic of Korea
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13
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King J, Tupper S, Fletcher K, Brose K, Goodridge D. The current practice of social work in pain management: a scoping review on chronic disease. SOCIAL WORK IN HEALTH CARE 2021; 60:256-271. [PMID: 33487135 DOI: 10.1080/00981389.2021.1878318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
While social workers have the capacity and scope of practice to make a significant contribution to pain management, little is understood about how they enact these roles. The initial goal of this scoping review was to examine the role of social work in pain management specifically in bleeding disorder care. Due to lack of published data on this topic, the review goal was broadened to chronic disease. Two electronic databases were searched providing a total of 13 published articles meeting the inclusion and exclusion criteria. Instrumental services, clinical services, and assessments were identified as primary roles of social workers, while advocacy, policy development, education, and skill development require further exploration in the literature.
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Affiliation(s)
- Jennifer King
- College of Medicine, University of Saskatchew, Saskatoon, Saskatchewan, Canada
| | - Susan Tupper
- Quality, Safety & Standards, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Kara Fletcher
- Faculty of Social Work, University of Regina, Saskatoon, Saskatchewan, Canada
| | - Kelsey Brose
- Hematology, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchew, Saskatoon, Saskatchewan, Canada
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Tauben DJ, Langford DJ, Sturgeon JA, Rundell SD, Towle C, Bockman C, Nicholas M. Optimizing telehealth pain care after COVID-19. Pain 2020; 161:2437-2445. [PMID: 32826752 PMCID: PMC7566302 DOI: 10.1097/j.pain.0000000000002048] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022]
Affiliation(s)
- David J. Tauben
- Departments of Anesthesiology & Pain Medicine
- Medicine, University of Washington, Seattle, WA, United States
| | | | | | - Sean D. Rundell
- Departments of Rehabilitation Medicine
- Health Services, University of Washington, Seattle, WA, United States
| | - Cara Towle
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Christina Bockman
- Department of Pharmacy, University of Washington, Harborview Medical Center, Seattle, WA, United States
| | - Michael Nicholas
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Kumar P, Turton A, Cramp M, Smith M, McCabe C. Management of hemiplegic shoulder pain: A UK‐wide online survey of physiotherapy and occupational therapy practice. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e1874. [PMID: 33241633 DOI: 10.1002/pri.1874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Praveen Kumar
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Ailie Turton
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Mary Cramp
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Mark Smith
- Leith Community Treatment Centre Edinburgh Scotland UK
| | - Candy McCabe
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
- Dorothy House Hospice Care Winsley UK
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El-Akkad SED, Nolan S, Fairbairn N, Ye M, Wu A, Barrios R, Montaner J, Ti L. The impact of high-dose opioid prescription on mortality rates among people living with HIV: A retrospective cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102705. [PMID: 32143186 PMCID: PMC7302960 DOI: 10.1016/j.drugpo.2020.102705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/25/2019] [Accepted: 02/16/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES High-dose opioid use is associated with increased morbidity, mortality, and healthcare utilization. People living with HIV (PLHIV) are frequently prescribed these medications to manage their pain. However, little is known about the relationship between being prescribed high doses of opioids (> 90 MME/d) and mortality risk among this population. The objective of this study was to examine the trends in mortality and the relationship between high-dose opioid analgesic prescribing and mortality among PLHIV. METHODS Utilizing the STOP HIV/AIDS cohort--a population-level linked database of treatment of PLHIV in British Columbia--we conducted bivariable and multivariable generalized estimating equation (GEE) models with a Poisson distribution to examine the relationship between high-dose opioid prescription and all-cause mortality rates in the study sample. RESULTS Between 1996 and 2015, 9272 PLHIV were included in the study. Age- and sex-adjusted mortality rate (using the 2011 Canadian population as the reference) was 30.99 per 1000 person-years (95% confidence interval [CI]: 28.11-33.88). In a multivariable GEE model with adjustment for various demographic and clinical confounders, there was a positive and independent association between being prescribed high-dose opioids and all-cause mortality rates (adjusted rate ratio [ARR] = 3.01; 95%CI: 2.47-3.66). DISCUSSION We found that mortality rates were significantly higher among PLHIV who were prescribed high-dose opioids compared to those who were prescribed lower doses. Our results highlight the risk associated with the prescribing of high-dose opioids to manage HIV-related pain and emphasize the need to explore non-opioid approaches to pain management.
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Affiliation(s)
- Saif-El-Din El-Akkad
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Research Scientist & Health Administrative Data Lead, B.C. Centre on Substance Use Assistant Professor, Department of Medicine, University of British Columbia, 400-1045 Howe Street Vancouver, BC, Canada, V6Z 2A9
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Research Scientist & Health Administrative Data Lead, B.C. Centre on Substance Use Assistant Professor, Department of Medicine, University of British Columbia, 400-1045 Howe Street Vancouver, BC, Canada, V6Z 2A9
| | - Monica Ye
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Anthony Wu
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Julio Montaner
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Lianping Ti
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Research Scientist & Health Administrative Data Lead, B.C. Centre on Substance Use Assistant Professor, Department of Medicine, University of British Columbia, 400-1045 Howe Street Vancouver, BC, Canada, V6Z 2A9.
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Gerretsen P, Shah P, Logotheti A, Attia M, Balakumar T, Sulway S, Ranalli P, Dillon WA, Pothier DD, Rutka JA. Interdisciplinary integration of nursing and psychiatry (INaP) improves dizziness‐related disability. Laryngoscope 2019; 130:1800-1804. [DOI: 10.1002/lary.28352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/14/2019] [Accepted: 09/19/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging GroupResearch Imaging Centre, Campbell Mental Health Research Institute, Centre for Addiction & Mental Health Toronto Canada
- Institute of Medical ScienceUniversity of Toronto Toronto Canada
- Department of PsychiatryUniversity of Toronto Toronto Canada
- Centre for Mental HealthUniversity Health Network Toronto Canada
| | - Parita Shah
- Multimodal Imaging GroupResearch Imaging Centre, Campbell Mental Health Research Institute, Centre for Addiction & Mental Health Toronto Canada
- Institute of Medical ScienceUniversity of Toronto Toronto Canada
| | - Anastasia Logotheti
- Multimodal Imaging GroupResearch Imaging Centre, Campbell Mental Health Research Institute, Centre for Addiction & Mental Health Toronto Canada
| | - Mohamed Attia
- Department of PsychiatryUniversity of Toronto Toronto Canada
| | - Thushanthi Balakumar
- Multimodal Imaging GroupResearch Imaging Centre, Campbell Mental Health Research Institute, Centre for Addiction & Mental Health Toronto Canada
| | - Shaleen Sulway
- Department of Otolaryngology–Head and Neck SurgeryToronto General Hospital, University of Toronto Toronto Canada
| | - Paul Ranalli
- Department of Otolaryngology–Head and Neck SurgeryToronto General Hospital, University of Toronto Toronto Canada
| | - Wanda A. Dillon
- Department of Otolaryngology–Head and Neck SurgeryToronto General Hospital, University of Toronto Toronto Canada
| | - David D. Pothier
- Department of Otolaryngology–Head and Neck SurgeryToronto General Hospital, University of Toronto Toronto Canada
| | - John A. Rutka
- Department of Otolaryngology–Head and Neck SurgeryToronto General Hospital, University of Toronto Toronto Canada
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A Systematic Review and Meta-Analysis of the Effectiveness of Psychological Interventions Delivered by Physiotherapists on Pain, Disability and Psychological Outcomes in Musculoskeletal Pain Conditions. Clin J Pain 2019; 34:838-857. [PMID: 29554030 DOI: 10.1097/ajp.0000000000000601] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis examined the effectiveness of physiotherapist delivered psychological interventions combined with physiotherapy on pain, disability, and psychological outcomes for patients with musculoskeletal pain conditions. METHODS The review was conducted in accordance with the (PRISMA) guidelines. Five databases were systematically searched for randomized controlled trials from inception to May 2016. Studies were required to compare a psychological intervention delivered by physiotherapists combined with physiotherapy to physiotherapy alone or usual care. Physiotherapists delivering the interventions must have undergone training by a psychologist or a health professional trained in the delivery of psychological interventions. RESULTS A total of 34 articles met the eligibility criteria, of those, 30 were suitable for meta-analysis. There was low to high quality evidence that physiotherapist delivered psychological intervention combined with physiotherapy decreased pain in the short (26 studies, mean difference=-0.37; 95% confidence interval [CI], -0.65 to -0.09) and long term (22 studies, mean difference=-0.38; 95% CI, -0.67 to -0.10) and decreased disability in the short term (29 studies, standardized mean difference =-0.14; 95% CI, -0.26 to -0.01). Effect sizes were small. Low to high quality evidence demonstrated small to medium effects for some psychological outcomes at short-term and long-term follow-ups. DISCUSSION The results indicate that psychological interventions delivered by physiotherapist show promise to improve health outcomes, particularly psychological outcomes, in musculoskeletal pain conditions.
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Curtis LH, Dember LM, Vazquez MA, Murray D, DeBar L, Staman KL, Septimus E, Mor V, Volandes A, Wells BL, Huang SS, Green BB, Coronado G, Meyers CM, Tuzzio L, Hernandez AF, Sugarman J. Addressing guideline and policy changes during pragmatic clinical trials. Clin Trials 2019; 16:431-437. [PMID: 31084378 PMCID: PMC6663617 DOI: 10.1177/1740774519845682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
While conducting a set of large-scale multi-site pragmatic clinical trials involving high-impact public health issues such as end-stage renal disease, opioid use, and colorectal cancer, there were substantial changes to both policies and guidelines relevant to the trials. These external changes gave rise to unexpected challenges for the trials, including decisions regarding how to respond to new clinical practice guidelines, increased difficulty in implementing trial interventions, achieving separation between treatment groups, and differential responses across sites. In this article, we describe these challenges and the approaches used to address them. When deliberating appropriate action in the face of external changes during a pragmatic clinical trial, we recommend considering the well-being of the participants, clinical equipoise, and the strength and quality of the evidence associated with the change; involving those charged with data and safety monitoring; and where possible, planning for potential external changes as the trial is being designed. Any solution must balance the primary obligation to protect the well-being of participants with the secondary obligation to protect the integrity of the trial in order to gain meaningful answers to important public health questions.
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Affiliation(s)
- Lesley H Curtis
- Lesley Curtis, PhD, (Corresponding Author) Duke University School of Medicine, 2200 West Main Street, Suite 720-A, Erwin Square Building, Durham, NC 27705, USA , Phone: (919) 681-6709
| | - Laura M Dember
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Miguel A Vazquez
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David Murray
- National Institutes of Health, Bethesda, MD, USA
| | - Lynn DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Edward Septimus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Vincent Mor
- Department of Health Services, Policy & Practice, Brown University School of Public Health and Providence Veterans Administration Medical Center, Providence, RI, USA
| | | | - Barbara L Wells
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, MD, USA
| | - Susan S Huang
- University of California Irvine School of Medicine, Irvine, CA, USA
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gloria Coronado
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Catherine M Meyers
- Office of Clinical and Regulatory Affairs, National Center for Complementary and Integrative Health (NCCIH), Bethesda, MD, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Adrian F Hernandez
- Lesley Curtis, PhD, (Corresponding Author) Duke University School of Medicine, 2200 West Main Street, Suite 720-A, Erwin Square Building, Durham, NC 27705, USA , Phone: (919) 681-6709
| | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Bhat S, Kroehl M, Yi WM, Jaeger J, Thompson AM, Lam HM, Loeb D, Trinkley KE. Factors influencing the acceptance of referrals for clinical pharmacist managed disease states in primary care. J Am Pharm Assoc (2003) 2019; 59:336-342. [PMID: 30948239 DOI: 10.1016/j.japh.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/12/2018] [Accepted: 02/19/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Clinical pharmacists use population health methods to generate chronic disease management referrals for patients with uncontrolled chronic conditions. The purpose of this study was to compare primary care providers' (PCPs) referral responses for 4 pharmacist-managed indications and to identify provider and patient characteristics that are predictive of PCP response. DESIGN Retrospective cohort study. SETTING This study occurred in an academic internal medicine clinic. PARTICIPANTS Clinical pharmacy referrals generated through a population health approach between 2012 and 2016 for hypertension, chronic pain, depression, and benzodiazepine management were included. MAIN OUTCOME MEASURES Proportion of referrals accepted, left pending, or rejected and influencing provider and patient characteristics. RESULTS Of 1769 referrals generated, PCPs accepted 869 (49%), left pending 300 (17%), and rejected 600 (34%). Compared with referrals for hypertension, benzodiazepine management, and depression, chronic pain referrals had the lowest likelihood of rejection (odds ratio [OR] 0.31; 95% CI 0.19-0.49). Depression referrals had an equal likelihood of being accepted or rejected (OR 1.04; 95% CI 0.66-1.64). Provider characteristics were not significantly associated with referral response, but residents were more likely to accept referrals. Patient characteristics associated with lower referral rejection included black race (OR 0.39; 95% CI 0.18-0.87), higher systolic blood pressure (OR 0.98; 95% CI 0.97-0.99), and missed visits (OR 0.24; 95% CI 0.07-0.81). CONCLUSION The majority of referrals for clinical pharmacists in primary care settings were responded to, varying mostly between acceptance and rejection. There was variability in referral acceptance across indications, and some patient characteristics were associated with increased referral acceptance.
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Multimodal pain therapy in chronic noncancer pain-gold standard or need for further clarification? Pain 2019; 158:1853-1859. [PMID: 28328572 DOI: 10.1097/j.pain.0000000000000902] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Giannitrapani KF, Glassman PA, Vang D, McKelvey JC, Thomas Day R, Dobscha SK, Lorenz KA. Expanding the role of clinical pharmacists on interdisciplinary primary care teams for chronic pain and opioid management. BMC FAMILY PRACTICE 2018; 19:107. [PMID: 29970008 PMCID: PMC6031118 DOI: 10.1186/s12875-018-0783-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 05/31/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Facilitating appropriate and safe prescribing of opioid medications for chronic pain management in primary care is a pressing public health concern. Interdisciplinary team-based models of primary care are exploring the expansion of clinical pharmacist roles to support disease management for chronic conditions, e.g. pain. Our study aims to 1) identify roles clinical pharmacists can assume in primary care team based chronic pain care processes and 2) understand the barriers to assuming these expanded roles. METHODS Setting: Veterans Health Administration (VA) has implemented an interdisciplinary team-based model for primary care which includes clinical pharmacists. DESIGN We employed an inductive two part qualitative approach including focus groups and semi-structured interviews with key informants. PARTICIPANTS 60 members of VA primary care teams in two states participated in nine preliminary interdisciplinary focus groups where a semi-structured interview guide elucidated provider experiences with screening for and managing chronic pain. To follow up on emergent themes relating to clinical pharmacist roles, an additional 14 primary care providers and clinical pharmacists were interviewed individually. We evaluated focus group and interview transcripts using the method of constant comparison and produced mutually agreed upon themes. RESULTS Clinical pharmacists were identified by primary care providers as playing a central role with the ongoing management of opioid therapy including review of the state prescription drug monitoring program, managing laboratory screening, providing medication education, promoting naloxone use, and opioid tapering. Specific barriers to clinical pharmacists role expansion around pain care include: limitations of scopes of practice, insufficient institutional support (low staffing, dedicated time, insufficient training, lack of interdisciplinary leadership support), and challenges and opportunities for disseminating clinical pharmacists' expanded roles. CONCLUSIONS Expanding the role of the clinical pharmacist to collaborate with providers around primary care based chronic pain management is a promising strategy for improving pain management on an interdisciplinary primary care team. However, expanded roles have to be balanced with competing responsibilities relating to other conditions. Interdisciplinary leadership is needed to facilitate training, resources, adequate staffing, as well as to prepare both clinical pharmacists and the providers they support, about expanded clinical pharmacists' scopes of practice and capabilities.
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Affiliation(s)
- Karleen F Giannitrapani
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA, 94025, USA.
| | - Peter A Glassman
- VA Greater Los Angeles Health Care System, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), Los Angeles, CA, 90073, USA.,David Geffen School of Medicine, University of California, Los Angeles, 10945 Le Conte Ave, Los Angeles, CA, 90024, USA
| | - Derek Vang
- VA Minneapolis Center for Chronic Disease Outcomes Research (CCDOR), 5445 Minnehaha Avenue South, Minneapolis, MN, 55417, USA
| | - Jeremiah C McKelvey
- VA Northern California Health Care System, 10535 Hospital Way, Mather, CA, 95655, USA
| | - R Thomas Day
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA, 94025, USA
| | - Steven K Dobscha
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.,Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park RD, Portland, OR, 97239, USA
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA, 94025, USA.,Stanford Medical School, Palo Alto, CA, 94305, USA.,RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
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Kear C, McKeithen T, Robertson S. ER/LA opioid REMS and accredited education: Survey results provide insight into clinical roles, educational needs, and learner preferences. Subst Abus 2018; 38:145-149. [PMID: 28418777 DOI: 10.1080/08897077.2017.1303422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Collaborative for REMS (Risk Evaluation and Mitigation Strategy) Education (CO*RE) includes 13 organizations that provide REMS Program Companies (RPC) grant-supported accredited education on extended-release and long-acting (ER/LA) opioid therapy. This report summarizes results of a survey designed to investigate the impact of participant criteria and to better understand the roles and preferences of continuing medical education/continuing education (CME/CE) participants. METHODS In April 2015, the authors made an online survey available to an estimated 10,000 clinicians who had completed a CO*RE CME/CE activity since 2013. The purpose of the survey was to (1) examine possible reasons learners may underreport prescribing status, (2) investigate ways in which learners engage in nonprescribing roles relevant to reducing adverse patient outcomes, and (3) determine the acceptability of a potential test-based learning tool that allows participants with mastery to test out in lieu of participating in 2- to 3-hour education. RESULTS Findings revealed that there was little confusion or reluctance by learners to answer questions about Drug Enforcement Administration (DEA) licensing and whether they prescribed opioids in the past year. REMS "prescriber" education covers opioid management responsibilities that are distributed among team members who play critical nonprescribing roles in reducing serious adverse outcomes from both ER/LA and immediate-release (IR) opioids. Seventy-three percent of study participants would favor a test-based learning tool should future circumstances warrant it. CONCLUSION The authors concluded the likelihood of underreporting is small, but there is an opportunity to clarify license and prescribing questions; opioid management responsibilities are distributed among nonprescribing team members who play roles in reducing adverse outcomes from both ER/LA and IR opioids, who would therefore benefit from REMS education; and clinicians favor a test-based learning tool, should future circumstances warrant it. These findings could have implications for planning future ER/LA opioid REMS curriculum and for setting and interpreting training goals for the US Food and Drug Administration's (FDA) ER/LA opioid REMS program.
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Affiliation(s)
- Cynthia Kear
- a California Academy of Family Physicians , San Francisco , California , USA
| | - Tom McKeithen
- b Healthcare Performance Consulting , Statesboro , Georgia , USA
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Which Point-of-Care Tests Would Be Most Beneficial to Add to Clinical Practice?: Findings From a Survey of 3 Family Medicine Clinics in the United States. POINT OF CARE 2017; 16:168-172. [PMID: 29333106 PMCID: PMC5737459 DOI: 10.1097/poc.0000000000000151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Point-of-care tests (POCTs) are increasingly used in family medicine to facilitate screening, diagnosis, monitoring, treatment, and referral decisions for a variety of conditions. Point-of-care tests that clinicians believe might be beneficial to add to clinical practice and the conditions for which they would be most useful in family medicine remain poorly understood in the United States. Methods Forty-two clinicians at 3 family medicine residency clinics completed a brief survey asking which POCTs they believed would be beneficial to add to their clinical practice and the conditions POCTs would be most useful for. We calculated frequencies of reported POCTs and conditions using descriptive statistics. Results Clinicians identified 34 POCTs that would be beneficial to add to family medicine, of which hemoglobin A1c, chemistry panels, and human immunodeficiency virus and gonococcal and/or chlamydia were most frequently reported and anticipated would be used weekly. Clinicians reported 30 conditions for which they considered POCTs would be useful. Diabetes mellitus, sexually transmitted infections, and respiratory tract infections were the most often reported and were identified as benefiting diagnosis, monitoring, and treatment decisions. Conclusions Clinicians identified a number of POCTs they viewed as being beneficial to add to their routine clinical practice, mostly to inform diagnosis and treatment planning. Some POCTs identified are available in the United States; thus, understanding barriers to implementation of these POCTs in primary care settings is necessary to optimize adoption.
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Jukiewicz DA, Alhofaian A, Thompson Z, Gary FA. Reviewing opioid use, monitoring, and legislature: Nursing perspectives. Int J Nurs Sci 2017; 4:430-436. [PMID: 31406787 PMCID: PMC6626213 DOI: 10.1016/j.ijnss.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/17/2017] [Accepted: 09/04/2017] [Indexed: 11/30/2022] Open
Abstract
The phenomena of prescription opioid misuse and abuse have a complicated history of contributing factors including policies, practices, and prescribing leading to contemporary phenomena. Some factors implicated in the opioid drug abuse problem include inefficient prescribing and improper use, lack of knowledge related to interpretation and assessment of pain levels, and decreased oversight and regulation from government and policy agents. Nurses, often frontline providers, need to be knowledgeable and embrace the guidelines, and necessary implications associated with both prescribing and administration of opioids. Additionally, all providers including physicians, physician assistants, nurse practitioners, and bedside nurses must have a firm understanding of the improper use and abuse of opioids. The examination and review of opioid policies at the state and federal level has revealed inconsistency with regulations, policies, and guidelines that have lead to the current situation. The use of an interdisciplinary team with nurses and various other practitioners is a good strategy to help reduce this problem.
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Affiliation(s)
- Deniece A. Jukiewicz
- Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Ave., Cleveland, OH 44106, USA
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Giannitrapani KF, Ahluwalia SC, Day RT, Pisciotta M, Dobscha S, Lorenz K. Challenges to teaming for pain in primary care. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2017; 6:23-27. [PMID: 28711504 DOI: 10.1016/j.hjdsi.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 01/24/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
| | | | - R Thomas Day
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
| | - Maura Pisciotta
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, USA
| | - Steven Dobscha
- Department of Psychiatry, Oregon Health & Science University, USA
| | - Karl Lorenz
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; The RAND Corporation, USA; Stanford School of Medicine, USA
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Case Studies from the Clinic: Initiating and Implementing Patient-Reported Outcome Measures. EGEMS 2017; 5:7. [PMID: 29930956 PMCID: PMC5994950 DOI: 10.5334/egems.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Self-reporting by patients though the use of electronic patient-reported outcome (PRO) measures has been shown to use increase patient satisfaction with care, and improve patient-provider communication, symptom management, and health quality. Additionally, PROs are increasingly used in research to expand understanding regarding the relative risks, benefits, and burdens of interventions. While experience embedding patient-reported outcomes (PROs) into registries and clinical workflow is growing, there is little in the literature to guide those interested in incorporating PROs into routine clinical care and for use in research. Case Descriptions The NIH Health Care Systems Research Collaboratory PRO Core interviewed investigators from seven programs to get their first-hand experiences on the incorporation of PROs for both care and research, and the investigators have contributed to this manuscript as authors. Findings We use these case studies to present practical approaches to initiating and implementing PROS, including instrument selection, tips for integrating PRO collection systems into clinical workflow, considerations for user experience and data collection, and the methods to assess and monitor quality. Conclusion Because the decision to initiate and implement PRO collection impacts many different stakeholders, the solution requires collaboration among the involved parties, careful planning, and integration into clinical workflow.
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Becker WC, Dorflinger L, Edmond SN, Islam L, Heapy AA, Fraenkel L. Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC FAMILY PRACTICE 2017; 18:41. [PMID: 28320337 PMCID: PMC5359906 DOI: 10.1186/s12875-017-0608-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/01/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Consensus guidelines recommend multi-modal chronic pain treatment with increased uptake of non-pharmacological pain treatment modalities (NPMs). We aimed to identify the barriers and facilitators to uptake of evidence-based NPMs from the perspectives of patients, nurses and primary care providers (PCPs). METHODS We convened eight separate groups and engaged each in a Nominal Group Technique (NGT) in which participants: (1) created an individual list of barriers (and, in a subsequent round, facilitators) to uptake of NPMs; (2) compiled a group list from the individual lists; and (3) anonymously voted on the top three most important barriers and facilitators. In a separate process, research staff reviewed each group's responses and categorized them based on staff consensus. RESULTS Overall, 26 patients (14 women) with chronic pain participated; their mean age was 55. Overall, 14 nurses and 12 PCPs participated. Seven healthcare professionals were men and 19 were women; the mean age was 45. We categorized barriers and facilitators as related to access, patient-provider interaction, treatment beliefs and support. Top-ranked patient-reported barriers included high cost, transportation problems and low motivation, while top-ranked facilitators included availability of a wider array of NPMs and a team-based approach that included follow-up. Top-ranked provider-reported barriers included inability to promote NPMs once opioid therapy was started and patient skepticism about efficacy of NPMs, while top-ranked facilitators included promotion of a facility-wide treatment philosophy and increased patient knowledge about risks and benefits of NPMs. CONCLUSIONS In a multi-stakeholder qualitative study using NGT, we found a diverse array of potentially modifiable barriers and facilitators to NPM uptake that may serve as important targets for program development.
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Affiliation(s)
- William C. Becker
- West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale University School of Medicine, New Haven, CT USA
| | | | - Sara N. Edmond
- West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale University School of Medicine, New Haven, CT USA
| | - Leila Islam
- University of Maryland School of Medicine, Baltimore, MD USA
| | - Alicia A. Heapy
- West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale University School of Medicine, New Haven, CT USA
| | - Liana Fraenkel
- West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale University School of Medicine, New Haven, CT USA
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Regueiro M, Greer JB, Szigethy E. Etiology and Treatment of Pain and Psychosocial Issues in Patients With Inflammatory Bowel Diseases. Gastroenterology 2017; 152:430-439.e4. [PMID: 27816599 DOI: 10.1053/j.gastro.2016.10.036] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/07/2016] [Accepted: 10/27/2016] [Indexed: 12/15/2022]
Abstract
There is increasing evidence that brain-gut interactions are altered during development of inflammatory bowel diseases (IBDs). Understanding the relationship between the neurobiology, psychological symptoms, and social ramifications of IBD can guide comprehensive care for the whole patient. The most common psychological conditions in patients with IBD are chronic abdominal pain, anxiety, and depression. We review the evidence-based data and rates of these conditions and their respective relationship to IBD and the diagnostic approaches to identify patients with these conditions. Different treatment options for pain and psychosocial conditions are discussed, and new models of team-based IBD care are introduced. Providing the health care provider with tools to diagnose and manage psychological conditions in patients with Crohn's disease or ulcerative colitis is necessary for their total care and should be part of quality-improvement initiatives.
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Affiliation(s)
- Miguel Regueiro
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julia B Greer
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eva Szigethy
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Jensen B. Chronic pain assessment from bench to bedside: lessons along the translation continuum. Transl Behav Med 2016; 6:596-604. [PMID: 27848210 PMCID: PMC5110487 DOI: 10.1007/s13142-015-0370-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The first step to providing effective healthcare is accurate assessment and diagnosis. The importance of accurate assessment is particularly important for chronic pain, given its subjective and multidimensional nature. The purpose of the current review is to discuss the dilemma of chronic pain assessment within a translational framework. First, assessment issues specific to chronic pain will be introduced along the entire continuum of translational activities. Important barriers along the continuum include inconsistent measurement of pain, possibly inaccurate preclinical models, and other practical limitations such as time, cost, and training. Second, the review will highlight promising areas worth further consideration in research and practice to bridge some of the gaps that currently impede effective chronic pain assessment and care. Specifically, consideration will be given to observational, biological, and technology-driven measures of chronic pain.
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Affiliation(s)
- Bryan Jensen
- Department of Psychology, Virginia Commonwealth University, PO Box 842018, Richmond, VA, 23284-2018, USA.
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Howie L, Hirsch B, Locklear T, Abernethy AP. Assessing the value of patient-generated data to comparative effectiveness research. Health Aff (Millwood) 2016; 33:1220-8. [PMID: 25006149 DOI: 10.1377/hlthaff.2014.0225] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The goal of comparative effectiveness research is to assess medical therapies and allow patients, health care providers, payers, and policy makers to make evidence-based decisions about the most appropriate therapies in routine clinical practice. To conduct this type of research and to inform health care delivery, data about the impact of interventions on patient outcomes are needed. Methods of generating evidence for comparative effectiveness research provide opportunities to engage patients and understand their experiences with illness and its treatment. In this article we assess the need for, uses of, and strengths and weaknesses of patient-generated data. We also review in brief federal and medical society efforts to create new streams of patient-generated data for clinical and research use. We observe that the key to high-quality patient-generated data is to have immediate and actionable data so that patients experience the importance of the data for their own care as well as research purposes. We conclude that leveraging the emerging wealth of "big data" being generated by patient-facing technologies such as systems to collect patient-reported outcomes data and patient-worn sensors is critical to developing the evidence base that informs decisions made by patients, providers, and policy makers in pursuit of high-value medical care.
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Affiliation(s)
- Lynn Howie
- Lynn Howie is a fellow in medical oncology at Duke University, in Durham, North Carolina
| | - Bradford Hirsch
- Bradford Hirsch is an assistant professor in the Center for Learning Health Care, Duke Clinical Research Institute, in Durham
| | - Tracie Locklear
- Tracie Locklear is research coordinator at the Center for Learning Health Care, Duke Clinical Research Institute
| | - Amy P Abernethy
- Amy P. Abernethy is director of the Center for Learning Health Care, Duke Clinical Research Institute, and a professor in the Duke University School of Medicine, in Durham
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Finestone HM, Juurlink DN, Power B, Gomes T, Pimlott N. Opioid prescribing is a surrogate for inadequate pain management resources. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:465-468. [PMID: 27302997 PMCID: PMC4907548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Hillel M Finestone
- Director of Stroke Rehabilitation Research at the Élisabeth Bruyère Hospital in Ottawa, Ont, and Professor in the Division of Physical Medicine and Rehabilitation in the Department of Medicine at the University of Ottawa.
| | - David N Juurlink
- Head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre in Toronto, Ont, and Eaton Scholar and Professor in the Department of Medicine, the Department of Paediatrics, and the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Barry Power
- Pharmacist with the Rideau Family Health Team in Ottawa
| | - Tara Gomes
- Scientist in the Li Ka Shing Knowledge Institute of St Michael's Hospital and with the Institute for Clinical and Evaluative Sciences and Assistant Professor in the Institute of Health Policy, Management and Evaluation and the Leslie Dan Faculty of Pharmacy at the University of Toronto
| | - Nicholas Pimlott
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Scientific Editor of Canadian Family Physician
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Finestone HM, Juurlink DN, Power B, Gomes T, Pimlott N. [La prescription d'opioïdes: un substitut au manque de ressources en contrôle de la douleur]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e287-e290. [PMID: 27303017 PMCID: PMC4907568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Hillel M Finestone
- Directeur de la recherche en réadaptation après un AVC à l'Hôpital Élisabeth-Bruyère à Ottawa, en Ontario, et professeur à la Division de la médecine physique et réadaptation du Département de médecine de l'Université d'Ottawa.
| | - David N Juurlink
- Directeur de la Division de pharmacologie clinique et de toxicologie au Centre des sciences de la santé Sunnybrook à Toronto, en Ontario, boursier Eaton et professeur au Département de médecine, au Département de pédiatrie et à l'Institute of Health Policy, Management and Evaluation de l'Université de Toronto
| | - Barry Power
- Pharmacien au sein de l'Équipe de santé familiale Rideau à Ottawa
| | - Tara Gomes
- Scientifique au Li Ka Shing Knowledge Institute de l'Hôpital St Michael et auprès de l'Institute for Clinical and Evaluative Sciences, de même que professeure adjointe à l'Institute of Health Policy, Management and Evaluation et à la Faculté de pharmacie Leslie Dan de l'Université de Toronto
| | - Nicholas Pimlott
- Professeur agrégé au Département de médecine familiale et communautaire de l'Université de Toronto et rédacteur scientifique du Médecin de famille canadien
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Chamay-Weber C, Farpour-Lambert NJ, Saunders Gasser C, Martin XE, Gal C, Maggio AB. Obesity Management in Adolescents: Comparison of a Low-Intensity Face-to-Face Therapy Provided by a Trained Paediatrician with an Intensive Multidisciplinary Group Therapy. Obes Facts 2016; 9:112-20. [PMID: 27054560 PMCID: PMC5644868 DOI: 10.1159/000443694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 12/23/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study aimed to compare the effects of a low-intensity face-to-face therapy provided by a trained paediatrician to an intensive group therapy provided by a multidisciplinary team on the BMI of adolescents with obesity. METHODS This longitudinal cohort study included 233 adolescents aged 11-18 years (mean 13.1 ± 1.7 years). Patients and their parents choose either a low-intensity face-to-face therapy or an intensive group therapy (total 88 h). RESULTS At baseline, the mean BMI was 29.4 ± 4.9 kg/m2. Within groups changes of BMI z-scores were significant at the end of follow-up both in the face-to-face (-0.2 ± 0.5) and the group therapy (-0.24 ± 0.5). There was no difference among groups. Younger age (12-14 years), gender, follow-up duration as well as BMI z-score at inclusion were significantly related to BMI z-score changes, independently of the type of intervention. As expected, the face-to-face therapy was far less expensive than the group therapy (USD 1,473.00 ± 816.00 vs. USD 6,473.00 ± 780.00). CONCLUSION A low-intensity face-to-face therapy resulted in similar changes of the BMI z-score of adolescents than an intensive multidisciplinary group therapy. This approach could be easily disseminated in primary care settings with a specific training in obesity care.
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Bergeron DA, Bourgault P, Gallagher F. Knowledge and Beliefs about Chronic Non Cancer Pain Management for Family Medicine Group Nurses. Pain Manag Nurs 2015; 16:951-8. [PMID: 26697819 DOI: 10.1016/j.pmn.2015.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/25/2022]
Abstract
To provide effective care for chronic pain sufferers, nurses must have a knowledge of chronic pain management. In Quebec, nurses working in Family Medicine Groups (FMGs) could play a major role in helping patients with chronic noncancer pain (CNCP); however, the extent of their knowledge about CNCP management is unknown. The primary goal of this study was to explore the knowledge and beliefs of FMG nurses about CNCP management. The secondary goal was to explore the obstacles seen by these nurses as preventing them from performing CNCP management. We used a mixed-methods design with quantitative preponderance. Fifty-three FMG nurses answered a self-administered mail-in questionnaire. A rigorous data collection method was used. FMG nurses have suboptimal knowledge about CNCP management. They identify their lack of training and lack of knowledge as major obstacles to conducting pain management interventions. There is a need for pain management training specifically designed around the realities of FMG nursing.
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Affiliation(s)
- Dave A Bergeron
- Department of Nursing, Université du Québec à Rimouski, Rimouski, Quebec, Canada.
| | | | - Frances Gallagher
- School of Nursing, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Guck TP, Burke RV, Rainville C, Hill-Taylor D, Wallace DP. A brief primary care intervention to reduce fear of movement in chronic low back pain patients. Transl Behav Med 2015; 5:113-21. [PMID: 25729460 DOI: 10.1007/s13142-014-0292-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fear avoidance model of chronic pain-based interventions are effective, but have not been successfully implemented into primary care. It was hypothesized that speed walking times and key measures of the fear avoidance model would improve following the brief intervention delivered in primary care. A brief primary care-based intervention (PCB) that included a single educational session, speed walking (an in vivo desensitization exposure task), and visual performance feedback was designed to reduce fear avoidance beliefs and improve function in 4 patients with chronic low back pain. A multiple baseline across subjects with a changing criterion design indicated that speed walking times improved from baseline only after the PCB intervention was delivered. Six fear avoidance model outcome measures improved from baseline to end of study and five of six outcome measures improved from end of study to follow-up. This study provides evidence for the efficacy of a brief PCB fear avoidance intervention that was successfully implemented into a busy clinic for the treatment of chronic pain.
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Affiliation(s)
- Thomas P Guck
- Department of Family Medicine, Creighton University School of Medicine, 1319 Leavenworth Street, Omaha, NE 68102 USA
| | - Raymond V Burke
- The Prevention Group; Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE USA
| | - Christopher Rainville
- Department of Family Medicine, Creighton University School of Medicine, 1319 Leavenworth Street, Omaha, NE 68102 USA
| | - Dreylana Hill-Taylor
- Department of Family Medicine, Creighton University School of Medicine, 1319 Leavenworth Street, Omaha, NE 68102 USA
| | - Dustin P Wallace
- Integrative Pain Management, Children's Mercy Hospitals and Clinics, School of Medicine, University of Kansas City-Missouri, Omaha, NE USA
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Resnick B. Consultant pharmacists, advanced practice nurses, and the interdisciplinary team. ACTA ACUST UNITED AC 2014; 29:149-53. [PMID: 24589764 DOI: 10.4140/tcp.n.2014.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although in geriatrics we are better than many other clinical disciplines in terms of providing interdisciplinary care to older adults, I hope that we will continue to recognize how much more could actually be done. Before addressing the relationship between advanced practice nurses (APNs) and consultant pharmacists in real world settings, I want to review teamwork in geriatrics in general. It is critical to define what we mean by team, what type of team, and what the goals are of this teamwork.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland
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Physical therapist-delivered cognitive-behavioral therapy: a qualitative study of physical therapists' perceptions and experiences. Phys Ther 2014; 94:197-209. [PMID: 24029300 DOI: 10.2522/ptj.20130047] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The importance of the biopsychosocial model in assessment and management of chronic musculoskeletal conditions is recognized. Physical therapists have been encouraged to develop psychologically informed practice. Little is known about the process of physical therapists' learning and delivering of psychological interventions within the practice context. OBJECTIVE The aim of this study was to investigate physical therapists' experiences and perspectives of a cognitive-behavioral-informed training and intervention process as part of a randomized controlled trial (RCT) involving adults with painful knee osteoarthritis. DESIGN A qualitative design was used. Participants were physical therapists trained to deliver pain coping skills training (PCST). METHODS Eight physical therapists trained to deliver PCST were interviewed by telephone at 4 time points during the 12-month RCT period. Interviews were audiorecorded, transcribed verbatim into computer-readable files, and analyzed using Framework Analysis. RESULTS Thematic categories identified were: training, experience delivering PCST, impact on general clinical practice, and perspectives on PCST and physical therapist practice. Physical therapists reported positive experiences with PCST and program delivery. They thought that their participation in the RCT had enhanced their general practice. Although some components of the PCST program were familiar, the therapists found delivering the program was quite different from regular practice. Physical therapists believed the PCST program, a 3- to 4-day workshop followed by formal mentoring and performance feedback from a psychologist for 3 to 6 months and during the RCT, was critical to their ability to effectively deliver the PCST intervention. They identified a number of challenges in delivering PCST in their normal practice. CONCLUSION Physical therapists can be trained to confidently deliver a PCST program. The physical therapists in this study believed that training enhanced their clinical practice. Comprehensive training and mentoring by psychologists was crucial to ensure treatment fidelity.
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