A new approach to chronic pain evaluation that allows patients to answers questions online or over the phone may lead to more accurate assessments of how well they’re benefiting from pain management, according to a team of researchers led by a professor at the Georgia State University School of Public Health.
“The treatment and clinical management of chronic pain is among the most vexing challenges currently facing primary care providers,” the researchers said. Despite recognition of the benefits of patients’ self-reported pain assessments, it’s typically not a routine part of clinical practice and is not integrated into most health care systems’ electronic records, they noted.
“As the dangers of the use of opioid medication as first-line treatment for chronic pain have become apparent, the need for such assessments is especially imperative,” the researchers said.
The study set up a clinical trial, the Pain Program for Active Coping and Training (PPACT), which was conducted in three regions of the Kaiser Permanente health care system: Georgia, Hawaii and Northwest (Oregon and southwest Washington). Assessing the scope of patients’ pain on a quarterly basis allowed clinicians to meet state regulatory requirements related to patient safety without being overly burdensome, the researchers said.
Researchers devised a three-tier system for administering patient pain assessments and collecting data: First, patients were given the opportunity to answer questions online in a format tied to their electronic personal health records. Patients who did not respond online within seven days received an automated phone call from Kaiser Permanente that used interactive voice technology to ask questions and record answers. Patients who were not reached or did not complete the assessment through the automated phone call within five days were contacted directly by clinical staff working with the research team.
Results of the clinical trial are published in the Journal of General Internal Medicine in the article “Automating Collection of Pain-Related Patient-Reported Outcomes to Enhance Clinical Care and Research.” The study’s lead author is Dr. Ashli Owen-Smith, assistant professor of health management and policy at Georgia State and an affiliated investigator with Kaiser Permanente.
PPACT’s tiered approach resulted in a completion rate of 86 percent, with little difference in response rates across demographic groups, with the exception of age. Older patients were more likely to respond to both online and to automated calls than younger study participants.
Among a group of 632 patients who had been part of PPACT’s clinical trial for at least one year, 96 percent completed a pain assessment. This rate was higher than the group’s completion of such assessments in a doctor’s office, clinic or hospital, which was 74 percent.