Does Screening for Pain Correspond to High Quality Care for Veterans?

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2010 Mar 16

PMID 20229139

Citations 12

Authors

Lisa Zubkoff

Karl A Lorenz

Andy B Lanto

Cathy D Sherbourne

Joy R Goebel

Peter A Glassman

Lisa R Shugarman

Lisa S Meredith

Steven M Asch

Affiliations

Soon will be listed here.

Abstract

Background: Routine numeric screening for pain is widely recommended, but its association with overall quality of pain care is unclear.

Objective: To assess adherence to measures of pain management quality and identify associated patient and provider factors.

Design: A cross-sectional visit-based study.

Participants: One hundred and forty adult VA outpatient primary care clinic patients reporting a numeric rating scale (NRS) of moderate to severe pain (four or more on a zero to ten scale). Seventy-seven providers completed a baseline survey regarding general pain management attitudes and a post-visit survey regarding management of 112 participating patients.

Measurement And Main Results: We used chart review to determine adherence to four validated process quality indicators (QIs) including noting pain presence, pain character, and pain control, and intensifying pharmacological intervention. The average NRS was 6.7. Seventy-three percent of charts noted the presence of pain, 13.9% the character, 23.6% the degree of control, and 15.3% increased pain medication prescription. Charts were more likely to include documentation of pain presence if providers agreed that "patients want me to ask about pain" and "pain can have negative consequences on patient's functioning". Charts were more likely to document character of pain if providers agreed that "patients are able to rate their pain". Patients with musculoskeletal pain were less likely to have chart documentation of character of pain.

Conclusions: Despite routine pain screening in VA, providers seldom documented elements considered important to evaluation and treatment of pain. Improving pain care may require attention to all aspects of pain management, not just screening.

Citing Articles

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OHanlon C, Giannitrapani K, Lindvall C, Gamboa R, Canning M, Asch S J Gen Intern Med. 2021; 37(6):1429-1435.

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Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study.

Giannitrapani K, Silveira M, Azarfar A, Glassman P, Singer S, Asch S J Gen Intern Med. 2021; 36(7):1867-1874.

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Can Multidimensional Pain Assessment Tools Help Improve Pain Outcomes in the Perianesthesia Setting?.

Petti E, Scher C, Meador L, Van Cleave J, Reid M J Perianesth Nurs. 2018; 33(5):767-772.

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Improving pain care through implementation of the Stepped Care Model at a multisite community health center.

Anderson D, Zlateva I, Coman E, Khatri K, Tian T, Kerns R J Pain Res. 2016; 9:1021-1029.

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Towards a pain free hospital: an in-depth qualitative analysis of the pain experiences of head and neck cancer patients undergoing radiotherapy.

Pattison N, Brown M, Gubbay A, Peacock J, Ross J, Chapman S Br J Pain. 2016; 10(1):29-37.

PMID: 27551409 PMC: 4977963. DOI: 10.1177/2049463715599995.

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