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Witkin LR, Kasubhai A, Jiang SY, Gotian R. Understanding providers' perspectives using patient-reported outcomes in a pain management setting: a pilot study. Pain Manag 2024; 14:163-172. [PMID: 38573070 PMCID: PMC11229384 DOI: 10.2217/pmt-2023-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
Aim: This pilot study evaluated an electronic patient-reported outcomes collection system in pain management to understand providers' experiences using the data, and how it affects their patient interaction and guides their clinical decision-making. Materials & methods: Using stratified convenience sampling, nine semi-structured interviews were conducted with consented pain physicians. The transcribed, de-identified interviews were coded and analyzed. Results: Although most physicians utilized patient reported outcomes (PROs), one-third reported no significant change in their practice since implementation and 56% stated it does not influence their treatment recommendations. Conclusion: Despite the importance of measuring the impact of chronic pain on quality of life, there are significant limitations to the real-world use of PRO that may limit the patient's assessment and care.
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Affiliation(s)
- Lisa R Witkin
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Abha Kasubhai
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Silis Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Ruth Gotian
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
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2
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Basem JI, White RS, Chen SA, Mauer E, Steinkamp ML, Inturrisi CE, Witkin LR. The effect of obesity on pain severity and pain interference. Pain Manag 2021; 11:571-581. [PMID: 34102863 DOI: 10.2217/pmt-2020-0089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Obesity is one of the most prevalent comorbidities associated with chronic pain, which can severely interfere with daily living and increase utilization of clinical resources. We hypothesized that a higher level of obesity, measured by BMI, would be associated with increased pain severity (intensity) and interference (pain related disability). Materials & methods: Participant data was pulled from a multisite chronic pain outpatient database and categorized based on BMI. Results: A total of 2509 patients were included in the study. We found significant differences between BMI groups for all pain severity scores (worst, least, average, current) and total pain interference score. Obese patients had significantly higher scores than normal weight patients. Conclusion: We found obesity to be associated with increased pain severity and pain interference.
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Affiliation(s)
- Jade I Basem
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Stephanie A Chen
- Department of Anesthesiology, Columbia University Medical Center, New York, NY 10032, USA
| | - Elizabeth Mauer
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY 10065, USA
| | - Michele L Steinkamp
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
| | | | - Lisa R Witkin
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
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Williams A, Rushton A, Lewis JJ, Phillips C. Evaluation of the clinical effectiveness of a work-based mentoring programme to develop clinical reasoning on patient outcome: A stepped wedge cluster randomised controlled trial. PLoS One 2019; 14:e0220110. [PMID: 31365565 PMCID: PMC6668791 DOI: 10.1371/journal.pone.0220110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of clinical mentoring on postgraduate physiotherapists have been explored, but its impact on patient outcomes is unknown. The objective of this trial was to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes. METHODS In a stepped-wedge cluster RCT in the musculoskeletal physiotherapy outpatient departments of a large NHS organisation, 16 physiotherapists were randomised by cluster to receive the intervention-150 hours of mentored clinical practice-at one of 3 time periods; control was usual training. 441 patients submitted outcome measures: Patient-Specific Functional Scale (PSFS) (primary outcome measure), EQ-5D-5L, patient activation and patient satisfaction (secondary outcome measures). A further secondary outcome measure of physiotherapist performance was collected by an independent assessor observing the physiotherapists practice. RESULTS 80.0% of intervention patients achieved clinically significant PSFS scores compared with 63.8% of control patients. Binary logistic regression analysis modelling for time, cluster and patient characteristics showed strong statistical evidence for this difference (p = 0.023; odds ratio 4.24, 95%CI 1.22, 14.79). Physiotherapist performance scores improved from a mean of 47.8% (SD 3.60) pre-intervention to a mean of 56.0% (SD 4.24) (p<0.001). There was no statistical evidence for differences between groups on other secondary outcomes. CONCLUSION This is the first study that we aware of that provides patient outcomes measurement of an established educational intervention in physiotherapy, providing evidence that this type of intervention positively impacts patient outcomes and physiotherapist performance. This provides a basis for further research in education across other healthcare disciplines and outcome measures.
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Affiliation(s)
- Aled Williams
- University Hospital of Wales Physiotherapy Department, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - James J. Lewis
- Y Lab (Public Services Innovation Lab for Wales), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ceri Phillips
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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Moryl N, Dave V, Glare P, Bokhari A, Malhotra VT, Gulati A, Hung J, Puttanniah V, Griffo Y, Tickoo R, Wiesenthal A, Horn SD, Inturrisi CE. Patient-Reported Outcomes and Opioid Use by Outpatient Cancer Patients. THE JOURNAL OF PAIN 2018; 19:278-290. [PMID: 29154919 PMCID: PMC5811357 DOI: 10.1016/j.jpain.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 11/21/2022]
Abstract
The Memorial Sloan Kettering Pain Registry contains patient characteristics, treatments, and outcomes for a prospective cohort of 1,534 chronic pain cancer patients who were seen at outpatient pain service clinics. Average pain intensity (Brief Pain Inventory) was reported as mild by 24.6% of patients, moderate by 41.5%, and severe by 33.9%. The patient's report of average percent pain relief and health state (EuroQOL 5 dimensions) was inversely related to average pain intensity category, whereas measures of pain interference, number of worst pain locations, and physical and psychological distress were directly related to pain intensity category. Eighty-six percent of patients received an opioid at 1 or more clinic encounters. Regression analysis revealed that male sex or being younger (65 years of age or younger) was associated with a greater likelihood of an opioid ordered. Male sex nearly doubled the likelihood of a higher dose being ordered than female sex. Bivariate analysis found that patients receiving opioids reported significantly more pain relief than no-opioid patients. However, patients receiving opioids had higher pain interference scores, lower index of health state, and more physical distress than no-opioid patients Our results identify the need to consider opioid use and dosage when attempting to understand patient-reported outcomes (PROs) and factors affecting pain management. PERSPECTIVE This report describes the results of the analyses of PROs and patient-related electronic health record data collected under standard of care from cancer patients at outpatient pain management clinics of Anesthesiology and Palliative Care at the Memorial Sloan Kettering Cancer Center. Consideration of sex and age as predictors of opioid use is critical in attempting to understand PROs and their relationship to pain management.
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Affiliation(s)
- Natalie Moryl
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinnidhy Dave
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Glare
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ali Bokhari
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vivek T Malhotra
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amitabh Gulati
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Hung
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinay Puttanniah
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yvona Griffo
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roma Tickoo
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison Wiesenthal
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan D Horn
- Health System Innovation and Research Division, University of Utah School of Medicine, Salt Lake City, Utah
| | - Charles E Inturrisi
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pharmacology, Weill Cornell Medical College, New York, New York.
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Witkin LR, Zylberger D, Mehta N, Hindenlang M, Johnson C, Kean J, Horn SD, Inturrisi CE. Patient-Reported Outcomes and Opioid Use in Outpatients With Chronic Pain. THE JOURNAL OF PAIN 2017; 18:583-596. [PMID: 28088507 DOI: 10.1016/j.jpain.2016.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/17/2016] [Accepted: 12/27/2016] [Indexed: 12/26/2022]
Abstract
The Weill Cornell Medical College Pain Registry database contains patient characteristics, treatments, and outcomes for a prospective cohort of 1,159 chronic pain patients who were seen at the Weill Cornell Medical College Pain Medicine outpatient clinic from July 8, 2011 to December 10, 2014. Patients aged 45 to 64 years comprised 43% followed by age ≥ 65 years at 37%. Fifty-eight percent were female. Average pain intensity (Brief Pain Inventory) was reported as mild by 22.3% of patients, moderate by 34.7%, and severe by 43.0%. For each pain intensity category, patient's report of average percent pain relief and health state (EuroQOL 5 Dimensions) was inversely related to average pain intensity category, whereas measures of pain interference, number of worst pain locations, and physical and psychological distress were directly related to pain intensity category. Seventy-seven percent of patients received an opioid at 1 or more clinic encounters. Median daily opioid dose in morphine equivalents was 55 with a range from 2 to 1,145 morphine equivalents. Regression analysis revealed that being male was associated with greater likelihood of an opioid ordered and higher average dosage than being female. The registry can identify patient characteristics and treatments that provide new insights into chronic pain management. PERSPECTIVE This article describes results of analyses of patient-reported outcomes and patient-related electronic health record data collected under standard of care from a prospective cohort of chronic pain outpatients at a New York City pain management clinic. The registry provides an opportunity to learn how to improve individualized chronic pain management.
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Affiliation(s)
- Lisa R Witkin
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - David Zylberger
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Neel Mehta
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | | | - Christopher Johnson
- Health System Innovation and Research Division, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jacob Kean
- Health System Innovation and Research Division, University of Utah School of Medicine, Salt Lake City, Utah
| | - Susan D Horn
- Health System Innovation and Research Division, University of Utah School of Medicine, Salt Lake City, Utah
| | - Charles E Inturrisi
- Department of Pharmacology, Weill Cornell Medical College, New York, New York.
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Fogelman Y, Carmeli E, Minerbi A, Harash B, Vulfsons S. Specialized Pain Clinics in Primary Care: Common Diagnoses, Referral Patterns and Clinical Outcomes - Novel Pain Management Model. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1047:89-98. [PMID: 28980273 DOI: 10.1007/5584_2017_108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
An estimated 19% of the adult population in western countries lives with chronic pain. Pain management lies mainly within the primary care and community setting. We evaluated the outcome of a new model of secondary care clinics, conducted by primary care physicians with specialized training in pain medicine. Data on referral patterns, prevalence of pain diagnosis, and medication consumption were recorded at five secondary pain management clinics in the community setting. In total, 997 patients with pain attended 2,652 visits (average 2.7 visits per patient) during 12 mo. Patients' age ranged from 18 to 92 yr (mean 59 ± 19). Mean pain intensity on the first visit, evaluated by the visual analogue scale was 7.7/10. Myofascial pain syndrome was the most common diagnosis (82%). Treatment included dry needling or trigger point injection (82%), manual myofascial release (23%), and pharmacotherapy (38%). Significant short-term improvement after treatment was reported by 75% of patients, and 72% reported long-term improvement. Four percent were referred to tertiary care pain clinics, 5% were referred to other specialists, and 5% to imaging. Secondary, community-based pain clinics, run by specially-trained primary physicians, demonstrated feasibility. The vast majority of patients referred to the clinics were treated using simple, inexpensive modalities, while sparing referrals to unnecessary consultation visits, imaging tests, and medications.
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Affiliation(s)
- Yacov Fogelman
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 8 Efron Street, Haifa, Israel.
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, 199 Aba Khoushy Ave., Haifa, Israel
| | - Amir Minerbi
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 8 Efron Street, Haifa, Israel
| | - Baruch Harash
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 8 Efron Street, Haifa, Israel
| | - Simon Vulfsons
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 8 Efron Street, Haifa, Israel
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