Chronic Pain Management in Nurse Managed FQHC
Purposes/Aims
The purpose of this presentation is to describe an integrated model of care to address chronic pain through shared group medical appointments at a federally qualified nurse managed health center.
Rationale/Background:
-Colorado ranks No. 2 nationally for prescription drug misuse among people between the ages of 12 and 25. In Colorado, there were 4,030 deaths from opioids in 2000. In 2010, this number quadrupled to 16,651 and remains on the rise.
-When the electronic prescription drug monitoring program (PDMP) was introduced to Colorado, it allowed providers to identify patients who were “doctor shopping” by providing access to a centralized database accessible by prescribers and completed by pharmacies. Oftentimes, patients are dismissed from the practice for aberrant behavior, as taking time to assess for addiction is costly and time consuming and there are few resources for addiction treatment for the underinsured in the state.
Approach
Management of non-malignant chronic pain is supported by the guidelines from Washington State through the Agency Medical Directors’ Group. Although the guidelines suggest best practices for managing patients through individual appointments, practices use shared medical appointments for management of chronic pain. Shared medical appointments are one method in which to enhance the patient-provider relationship and embrace a multidisciplinary model that provides opportunity for additional education. Shared group medical visits provide information that extends beyond the time constraints limiting a provider in individual appointments. In addition, shared medical appointments are congruent with the integrated care model we utilize.
Outcomes achieved/documented
We use the CareOregan Pain Management Multidisciplinary Group visits curriculum.
Our first group visit was March of 2013 with 5 participants. We deemed shared group medical visits as a requirement for patients suffering from chronic pain who are prescribed opioids as part of their pain management regimen. There are 38 patients managed for chronic pain with opioids and 7 (18%) have completed the groups. There are currently two group sessions with a total of 8 participants. Once the current session is completed, ~ 39% of appropriates patients will have completed the required shared medical appointments with another group planned in Spring 2015.
Outcomes before the current sessions were observational in nature and included the number of patients who stated they began using non pharmacological approaches to pain management, number of patients who considered changing their opioid therapy from short acting to long acting opioid formulations, number of patients who went to the ED for pain management, patients who decided to taper off opioid medications. Additional outcomes have been identified the current sessions.
Conclusions
Shared group medical appointments are an appropriate manner in which to manage patients with non-malignant chronic pain and embrace an integrated health care philosophy. There is a need for more evidence that provides information regarding best practices and identification of curriculums that yield optimal outcomes for patients suffering from non-malignant chronic pain.