A Nurse Practitioner Modeled Patient-Centered Approach to Chronic Pain Management in Primary Care

Transcription

1 A Nurse Practitioner Modeled Patient-Centered Approach to Chronic Pain Management in Primary Care By Dr. Glenmore Hendricks, DNP, NP-C

2 Disclosure presenter

3 Objective ØDefine chronic pain ØDiscuss epidemiology of pain ØDescribe current state of NP practice ØDescribe the Patient-Centered Medical Home Model (PCMH) model in relation to chronic pain management ØIdentify barriers/ challenges for NPs

4 Epidemiology

5 Epidemiology- United States Ø 100 million adults experience chronic pain (2012) Ø $635 billion annually in economic cost Ø 20% of patients in primary care receive Opioids prescription Ø HCP wrote 259 million prescriptions for Opioid (2012) Ø 116 people die each day from Opioid OD (2017)

6 Annual cost Respiatory Dis, $112 Diabetes, $127 Chronic pain, $635 Cancer, $243 CVD, $309

7 State trend

8 Chronic pain Pain lasting more than 3 months or pass the time of normal tissue healing.

9 Chronic pain Low back pain Osteoarthritis Rheumatoid Arthritis Headache Neck pain Fibromyalgia Irritable bowel syndrome Other (i.e. cancer, carpel tunnel)

10 Dilemma Under prescribe Over prescribe Inadequate pain control Adverse outcomes

11 Psychological and social pitfalls Loss of productivity Sleep disturbance Reduce quality of life Chronic Pain Other physical problems Depression and anxiety Substance abuse

12 Chronic pain management Ø Improve prescriber s access to guidelines Ø Promote tools to diagnose and treat opioid use Ø Promote alternative evidence-based treatment for pain

13 Herbal treatment Petiveria alliacea- Guinea Hen Weed

14 Nurse Practitioners Ø248, 000 NPs ØPrescribe in all 50 states Ø916 million office visits in 2015 Ø18% practice in rural areas Ø2/3 of Americans see NPs for primary care needs

15 NP practice Ø Fastest growing primary care providers recognized in many states Ø Improves access to care Ø High quality care Ø Affordable cost Ø Full Practice Authority Ø Interprofessional collaboration Ø Affordable Care Act (ACA) funded Patient-Centered Medical Home (PCMH) to encourage NPs to pursue innovative practice models to manage chronic illnesses (2010)

16 What is a Patient-Centered Medical Home (PCMH)? Ø A healthcare model that delivers care that is accessible, coordinated, patient-centered, comprehensive and culturally effective. Ø Goal of PCMH model in chronic pain management is to deliver safe appropriate care, improve quality of life, and help reduce opioid over prescribing.

17 Patient-Centered Medical Home Model Community Resources Accessible services Co Patient-centered care Health System Comprehensive Care Coordinated care Quality and Safety Informed, Active Patient Productive Interaction Proactive Practice team Adequate pain control Reduce dependence on Opioid Improve Quality of life Improve psychological well-being Note. Adapted and modified from An Evaluation of Collaborative Interventions to Improve Chronic Illness Care, by S. Cretin, S.M. Shorttell, and E.B. Keeler, 2004, Evaluation Review, 28, p 30

18 Patient-Centered Medical Home Model Coordinated Care * Monitors care received by patient- referrals Accessible Services * Access to PCP or other members of IDT Comprehensive care * IDT to meet diverse needs of patient Quality and safety * Use of Evidence-based guidelines Supported by EHR Patient-Centered Care * Individualized care based on psychosocial needs Community Resources * Supportive care to improve functionality

19 Current evidence Title Design Results Patient-Centered Perspective on Treatment Outcomes in Chronic Pain O Brien et al. (2010) Integrating Interdisciplinary Pain Management into Primary Care: Development and Implementation of a Novel Clinical Program Dorflinger et al. (2014) Improving Pain Care with Project Echo in Community Health Centers Anderson et al. (2017) Health Care Systems Support to Enhance Patient-Centered Care: Lessons from a Primary Care-Based Chronic Pain Management initiative Elder et al. (2017) Retrospective correlational sample Program development and evaluation using PDSA approach Quasi-experimental, pre-post intervention w/ comparison group Qualitative analysis of minutes, interviews and focus groups Successful treatment depends on recognition and implementation of individualized treatment goals. Higher rates of engagement in specialty and multimodal pain care services. Increase patient and providers satisfaction. PCP increased knowledge and Efficacy. Opioid prescribing decreased Patient involvement with physician and staff enriched Patient-Centered experience/ process

20 Barriers SOP restrictions (Full Practice Authority) Inter-professional practice support Lack of community resources Limited/ no coverage from health plans (insurance)

21 Health policy Prescription monitoring programs- CURES Medication Assisted Therapy- MAT Comprehensive Addiction and Recovery Act- CARA Waivers for NPs and PAs Improves access to Naloxone and Suboxone Permanent authorization for qualifying NPs and PAs to treat patients with buprenorphine

22 Summary Ø Chronic pain a universal challenge ØNPs increase role as PCP in primary care ØPCMH model utilizing a multidisciplinary model for chronic pain management ØNPs active engagement in shaping policies affecting their practice

23 Innovation creates opportunity, Quality creates demand, but it takes a Team to make it work

24 References Creech, C. J., Clark, S., Grube, G., Louisell-McFawn, M., Rench, J., Wiltse, K., & McFarland, M. (2011). Nurse practitioner management of chronic musculoskeletal pain: a chart review. The Nurse practitioner, 36(9), Dorflinger, L. M., Ruser, C., Sellinger, J., Edens, E. L., Kerns, R. D., & Becker, W. C. J. P. M. (2014). Integrating interdisciplinary pain management into primary care: development and implementation of a Novel Clinical Program. 15(12), Elder, C. R., DeBar, L. L., Ritenbaugh, C., Rumptz, M. H., Patterson, C., Bonifay, A.,... Deyo, R. A. J. T. P. j. (2017). Health Care Systems Support to Enhance Patient-Centered Care: Lessons from a Primary Care-Based Chronic Pain Management Initiative. 21. Korthuis, P. T., McCarty, D., Weimer, M., Bougatsos, C., Blazina, I., Zakher, B.,... Chou, R. (2017). Primary care based models for the treatment of opioid use disorder: a scoping review. Annals of Internal Medicine, 166(4), Langford, D. J., Tauben, D. J., Sturgeon, J. A., Godfrey, D. S., Sullivan, M. D., & Doorenbos, A. Z. J. J. o. g. i. m. (2018). Treat the Patient, Not the Pain: Using a Multidimensional Assessment Tool to Facilitate Patient-Centered Chronic Pain Care O'brien, E. M., Staud, R. M., Hassinger, A. D., McCulloch, R. C., Craggs, J. G., Atchison, J. W.,... Robinson, M. E. J. P. M. (2010). Patient-centered perspective on treatment outcomes in chronic pain. 11(1), Peppin, J. F., Cheatle, M. D., Kirsh, K. L., & McCarberg, B. H. (2015). The complexity model: a novel approach to improve chronic pain care. Pain Med, 16(4), Reid, K. J., Harker, J., Bala, M. M., Truyers, C., Kellen, E., Bekkering, G. E., & Kleijnen, J. (2011). Epidemiology of chronic non-cancer pain in Europe: narrative review of prevalence, pain treatments and pain impact. Current Medical Research and Opinion, 27(2),

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