Design and baseline findings from a ... Home
Design and baseline findings from a randomized trial of collaborative care for chronic musculoskeletal pain in primary care
Steven K. Dobscha MD
Background
1. Half of patients in VA primary care clinics report chronic, non-cancer pain
2. Implementation of treatment guidelines for chronic pain care has been challenging
3. One approach to promoting guideline concordant care for chronic conditions is to use multifaceted, collaborative interventions.
Design: Cluster randomized clinical trial
Intervention
4. Based on the chronic care model
5. Includes patient and provider activation and education, patient assessment, outcomes monitoring, and feedback to providers
6. Lasts 12 months
7. Facilitated by Support Team: Full-time psychologist care manager and up to one day per week physician pain specialist (internist)
Results
8. 15% of general pool of primary care patients mailed a study advertisement letter requested screening for the study.
9. 401 patients and 42 primary care clinicians from 5 clinics are participating
10. Mean age of enrolled patients was 62
11. Back and neck or joint pain diagnoses were present in 67% and 65% of patients, respectively. Mean pain duration was 15 years, and mean Roland-Morris Disability score (range 0 to 24) was 14.7 (sd=4.4). 65% of patients were receiving disability.
12. At baseline, 18% of patients met criteria for major depression, 17%, post-traumatic stress disorder, and 9%, alcohol misuse.
13. 39% of patients felt strongly that experiencing pain was a sign of damage and 60% reported strong avoidance of painful activities.
14. At baseline, 71% of clinicians reported moderate or strong confidence in their ability to treat chronic pain, but 37% reported moderate or greater dissatisfaction with their ability to provide optimal pain treatment.
Conclusions
15. Recruitment proceeded well. Patients are interested in receiving pain care and/or participating in pain research
16. Psychiatric comorbidity is common in this patient population
Impacts
These baseline data support the rationale to develop a multifaceted approach to educate and activate patients, support primary care clinicians, and enhance detection and treatment of psychiatric comorbidity.
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