SAN DIEGO – Use of a standardized checklist with information describing opiate therapy and the source of the patient’s chronic pain improved resident and faculty satisfaction with management of chronic pain patients, results from a single-center study found.
"The management of chronic pain is so different for each individual patient, but the unique thing about this checklist is that it’s standardized to an entire panel," Dr. Filza Akhtar said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians. "It allows us to manage this panel of patients in a way that we feel gives us some control."
In an effort to increase compliance with the clinic opiate policy for family medicine resident patients with chronic pain, Dr. Akhtar and her associates in the department of family medicine at Oregon Health and Science University (OHSU), Portland, added a standardized checklist to the department’s existing electronic health records system (EHR) that contained elements of the clinic-wide chronic pain policy.
The checklist includes nine items: chronic pain source or diagnosis; pain contract date; last urine drug screen date; monthly medication dosage and fill number; functional goals such as activities of daily living and exercise; opiate abuse risk assessment; other modalities such as acupuncture, sauna, and massage; depression/bowel habits screening date; and statewide controlled substance registry query status and date.
The researchers surveyed family medicine residents before and after implementation of the checklist into the EHR to assess comfort and satisfaction with management of 132 adult patients with ongoing chronic pain conditions on their own panels who were seen during the 2011-2012 academic year. Family medicine faculty completed surveys to assess their comfort managing family medicine residents’ chronic pain patients when the residents were not available in clinic. The family medicine department at OHSU consists of 12 residents, 12 faculty physicians, and 8 advanced practice nurses/physician assistants.
On a 10-point Likert scale, residents’ comfort with managing their own patients receiving chronic opiates improved from a baseline average of 4.25 to 6.55 after implementation of the checklist. One survey participant noted that standardizing EHR and patient expectations regarding the use of chronic narcotics "greatly improved my happiness as a resident physician." Another survey participant commented that conversations in the exam room "were much easier with standardization in place. It also seemed to cut down on ‘doctor shopping’ at our clinic."
The faculty comfort with management of family medicine residents’ patients receiving chronic opiates also improved from a baseline of 4.73 to 5.69 after implementation of the checklist.
Another study author, Dr. Eric Chen, a family medicine resident at OHSU, acknowledged that trying to map out a course of care for patients receiving chronic opiates can be difficult. "It’s a very sensitive topic because it brings up a lot of charged views with new residents who come into a training program inheriting patients who are managed on these opioid regimens," he said. "This tool is used mainly as kind of a historical marker of what has been done. It can shape what [approach] the physician would like to take going forward."
The researchers stated that they had no relevant financial conflicts to disclose.