Panel-Based Pain Management in Primary Care Final rept. (Oct. 1, 1999-Dec. 31, 2003)

摘要

The purpose of this proposal was to evaluate the Dartmouth Clinical Improvement System (DCCIS) and a phone-based Nurse Educator intervention for the management of pain in primary care. Pain is one of the most common presenting problems in primary care and accounts of significant suffering for patients and personal and societal costs in terms of lost work days and increasing rates of disability and health care utilization. Unfortunately, pain is frequently not helped by standard interventions provided in primary care. Therefore, there is a need to evaluate innovative approaches to pain management in primary care. Patients were screened for the presence of pain and psychosocial problems utilizing the Dartmouth Improve Your Health Questionnaire. Patients reporting pain, but no psychosocial problems were randomized: (1) to receive the Dartmouth Clinical Improvement System or (2) to a Care as Usual Control group. Patients reporting pain plus significant psychosocial problems were randomized: (1) to receive the Dartmouth Clinical Improvement System; (2) to receive the Dartmouth Clinical Improvement System and the Nurse-Educator Phone Intervention; or (3) to a Care as Usual Control group. Primary outcomes were assessed with the SF-36 and the Functional Interference Estimate (FIE) at baseline, 6, and 12 months. No group differences in outcome were found for patients experiencing pain but no psychosocial problems. However, for patients with pain plus psychosocial problems, patients who were randomized to the Nurse Educator intervention demonstrated significantly greater improvement on the FIE and several subscales of the SF-36 as compared to patients in the DCCIS or Usual Care groups.