Lack of Time Lack of time is commonly cited as a reason for not using validated scales and tools provided in the toolkit. Consider implementing only one tool at a time. If no standardized guidelines are in place in your current practice, start with having each new patient complete a patient agreement. Set a goal to have existing patients complete patient agreement over the next three to six months. With EHRs creating a system when refills for controlled substances are initiated, physicians are prompted to complete necessary documentation after 90 days have passed from the date of initiation. Training staff to automatically facilitate this process as part of the patient follow-up visit can increase the adoption rate. With recent updates in E/M coding, physicians can bill for time spent reviewing medical records, previous treatments, and imaging in addition to the time spent with the patient. This allows physicians to be compensated for the extra work and time required to evaluate often medically complex patients. Review the chronic pain management toolkit and determine what tools best fit your practice setting. Develop a chronic pain management packet for all new patients and existing patients with similar time frames for completion. Review workflows within the clinic setting, introduce during the first visit, complete at next follow-up visit, and schedule additional time for “chronic pain management review.” The sample packet includes a brief pain inventory, Promis scale v1.2 Global health, ORT, and patient agreement. Lack of Familiarity with Guidelines/Tools When implementing any new clinic procedure or protocol, particularly with medically complex patients, resistance is to be expected. One technique that can be helpful to increase the use of validated scales provided in the toolkit is encouraging physicians to take the questionnaires themselves or administer them to a family member. This seems simple, but it works. It can be done quickly and, once familiar with the tools, the physician can determine which ones best suit their individual practice. For example, does this give you the information you need to know about your patient? Will it also increase your familiarity with scoring? * Barriers and facilitators are listed from most frequently (top) to less frequently (bottom) reported by participants. Originally published in Pain Medicine; reprinted with permission. Patient lack of self-management skills is increasingly reported as a source of burnout among physicians providing pain management care. For example, treating underlying depression with a multidimensional approach has shown to increase patient compliance and the ability to engage in nonpharmacologic behaviors to manage pain and reduce reliance on opioid pain medication. Using tools such as a brief pain inventory and global health scales provides insight into the patient ’s overall level of function. Using motivational interviewing helps patients set achievable goals. Chronic Pain| Continued on page 26 Table 1: Barriers and Facilitators to Using Pain Self-Management Strategies * Barriers Facilitators Pain interferes with self-management Improving depression after treatment Over-reliance on medications Supportive family and friends Limitations related to depression Support groups with peers Lack of tailoring to meet patient needs Support from nurse care managers Fear of activity Social comparison Ineffective pain relief from some strategies Being a proactive patient Lack of care manager support after study done Positive thinking Stressors Positive affirmations Time constraints Improving one’s self-esteem Lack of motivation or self-discipline Goal setting and achieving goals Lack of support from friends, family, or employers Providing a menu of different strategies to use Limited resources (e.g., transportation, financial) 25 |
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