Meeting high-risk patient pain care needs through intensive primary care: a secondary analysis

Karleen F Giannitrapani; Jesse R Holliday; Matthew D McCaa; Susan Stockdale; Alicia A Bergman; Marian L Katz; Donna M Zulman; Lisa V Rubenstein; Evelyn T Chang

doi:10.1136/bmjopen-2023-080748

Meeting high-risk patient pain care needs through intensive primary care: a secondary analysis

BMJ Open. 2024 Jan 2;14(1):e080748. doi: 10.1136/bmjopen-2023-080748.

Authors

Karleen F Giannitrapani^{1

2}, Jesse R Holliday³, Matthew D McCaa³, Susan Stockdale⁴, Alicia A Bergman⁴, Marian L Katz⁴, Donna M Zulman^{3

2}, Lisa V Rubenstein⁵, Evelyn T Chang^{4

6

7}

Affiliations

¹ Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System Menlo Park Division, Menlo Park, California, USA karleen@stanford.edu.
² Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.
³ Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System Menlo Park Division, Menlo Park, California, USA.
⁴ Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
⁵ Rand Corporation, Santa Monica, California, USA.
⁶ Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
⁷ Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.

Abstract

Objective: Chronic pain disproportionately affects medically and psychosocially complex patients, many of whom are at high risk of hospitalisation. Pain prevalence among high-risk patients, however, is unknown, and pain is seldom a focus for improving high-risk patient outcomes. Our objective is to (1) evaluate pain frequency in a high-risk patient population and (2) identify intensive management (IM) programme features that patients and providers perceive as important for promoting patient-centred pain care within primary care (PC)-based IM.

Design: Secondary observational analysis of quantitative and qualitative evaluation data from a multisite randomised PC-based IM programme for high-risk patients.

Setting: Five integrated local Veterans Affairs (VA) healthcare systems within distinct VA administrative regions.

Participants: Staff and high-risk PC patients in the VA.

Intervention: A multisite randomised PC-based IM programme for high-risk patients.

Outcome measures: (a) Pain prevalence based on VA electronic administrative data and (b) transcripts of interviews with IM staff and patients that mentioned pain.

Results: Most (70%, 2593/3723) high-risk patients had at least moderate pain. Over one-third (38%, 40/104) of the interviewees mentioned pain or pain care. There were 89 pain-related comments addressing IM impacts on pain care within the 40 interview transcripts. Patient-identified themes were that IM improved communication and responsiveness to pain. PC provider-identified themes were that IM improved workload and access to expertise. IM team member-identified themes were that IM improved pain care coordination, facilitated non-opioid pain management options and mitigated provider compassion fatigue. No negative IM impacts on pain care were mentioned.

Conclusions: Pain is common among high-risk patients. Future IM evaluations should consider including a focus on pain and pain care, with attention to impacts on patients, PC providers and IM teams.

Keywords: Chronic Pain; Organisation of health services; PAIN MANAGEMENT; Patient-Centered Care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Chronic Pain* / epidemiology
Chronic Pain* / therapy
Delivery of Health Care
Humans
Patient Care
Patient-Centered Care
United States / epidemiology
United States Department of Veterans Affairs
Veterans*

Grants and funding

IK2 HX003077/HX/HSRD VA/United States