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Article Title

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

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.

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Submitted

June 23rd, 2017

Accepted

August 10th, 2017