In the United States, the management of chronic pain in primary care has become overwhelming for primary care providers (PCPs) and ineffectual for patients. Now, a new study published in the Journal of Pain Research provides evidence that implementation of a Stepped Care Model for Pain Management (SCM-PM) has the potential to more adequately treat chronic pain.
There are over 100 million people in the US with chronic pain, the majority of whom seek help from a primary care provider, accounting for a third of all visits to primary care. However, the quality of pain care remains poor, since primary care providers receive limited pain care training and express low confidence in their ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented where pain is particularly common.
The SCM-PM calls for an individualized approach to managing pain in three steps. In Step 1, the clinician identifies and discusses the patient's pain concerns, and develops a treatment plan focusing on self-management and primary care-based interventions. Step 2 involves additional resources and collaborative treatment, including behavioral health assessment and interventions, medication, and consultations with specialists. Step 3 focuses on patients with chronic pain requiring significantly more care and involvement from other members of a pain management team.
In their study, entitled "Improving pain care through implementation of the Stepped Care Model at a multisite community health center," the authors, from the Weitzman Institute and University of Connecticut, USA, set out to evaluate the impact of implementing the SCM-PM on the quality of pain care over a large scale - over 25 primary care providers, including 7,742 patients with chronic pain (3,357 pre-intervention and 4,385 post-intervention) cared for at Community Health Center Inc. Data were collected from the electronic health record and chart reviews, and surveys were administered to primary care providers to assess knowledge, attitudes, and confidence.
They found that implementation of the SCM-PM resulted in clinically significant improvements in many quality of pain care outcomes. Providers' pain knowledge scores increased an average of 11%, and self-rated confidence in ability to manage pain also increased. Significant improvements were noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96%.
The study's lead author Dr Anderson said, "There is a compelling need to improve the management of pain in primary care. This initiative focused heavily on provider education and protocol-driven care and demonstrated modest but significant improvements in knowledge, self-efficacy and adherence to guidelines. These findings, if sustained, may translate into improved patient outcomes."
Dr Anderson thinks that changes brought in by the SCM-PM could go further than just pain management alone. He continued, "Positive changes in referral patterns and opioid prescribing suggest that structured improvement initiatives based on data and effective conceptual models can lead not only to increased knowledge acquisition, but also application of that knowledge in ways that have direct impact on patient care. These changes are likely to result in reduced pain, improved patient safety, and more confident, knowledgeable, satisfied health care teams."
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