A Shared Medical Appointment on the Benefits and Risks of Opioids in Chronic Pain Management: Evaluation of a Pilot Program in an Ambulatory Setting

Authors

Robert Romanelli, Palo Alto Medical Foundation Research Institute, Palo Alto, CAFollow
Marina Dolginsky, Palo Alto Medical Foundation, Palo Alto, CA
Yuliya Byakina, University of California, San Francisco, San Francisco, CA
Deborah Bronstein, Palo Alto Medical Foundation, Palo Alto, CA
Sandra Wilson, Palo Alto Medical Foundation Research Institute, Palo Alto, CA

Publication Date

8-10-2017

Keywords

human subjects research, program evaluation, communication, patients, providers, chronic disease, patient experience/satisfaction

Abstract

Background: We sought to evaluate a pilot shared medical appointment (SMA) designed to educate patients on the safe use of opioids and build empowerment in self-managing chronic pain (CP).

Methods: This prospective study was conducted at an ambulatory clinic within a health care system in Northern California. The pilot SMA began in February 2016. The SMA is a single 90-minute billable office appointment led by a primary care physician to a group of 15–20 patients. Patients were included in the study if they were adults with a CP condition and referred to the SMA by a clinic physician. Data were collected by a brief survey administered to patients immediately before and immediately after the SMA. In addition to demographics and clinical characteristics, the survey collected information on four patient-experience domains: 1) understanding of CP; 2) confidence in CP self-management; 3) confidence in health care providers’ ability to help manage CP; and 4) satisfaction with care received within the health care system for CP. Domains were measured on a scale of 0 (worst) to 5 (best). Mean differences in pre-post ratings were assessed by a paired t-test; P-value < 0.05 was considered statistically significant.

Results: Between February and August 2016, 130 patients attended the SMA and completed the survey. The majority of patients were ≥ 50 years of age (69.6%), and 56.2% were female. The most prevalent CP condition was back/neck pain (73.8%), followed by joint/bone pain (53.6%); 63.8% of patients reported > 1 CP condition. In a comparison of pre-post responses, patients showed statistically significant increases in confidence in self-managing CP (+0.44; 95% confidence interval [CI]: 0.29–0.59; P < 0.001) and in their health care providers' ability to help manage CP (+0.28; 95% CI: 0.14–0.43; P < 0.001). No changes were observed in patents’ understanding of, or satisfaction with care received for, CP.

Conclusion: In an ambulatory care setting among patients with various CP conditions, an SMA targeting the risk and benefits of opioids was associated with prompt improvements in patients’ confidence in self-managing CP and in their health care providers’ ability to help manage CP. Such confidence can lay the foundation for increased patient engagement and activation in pain management.

Recommended Citation

Romanelli R, Dolginksy M, Byakina Y, Bronstein D, Wilson S. A shared medical appointment on the benefits and risks of opioids in chronic pain management: evaluation of a pilot program in an ambulatory setting. J Patient Cent Res Rev. 2017;4:164-5.