Recorded presentation

Carole Upshur, EdD, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Ave. North, Worcester, MA 01655, 508-334-7267, carole.upshur@umassmed.edu and Judith Savageau, MPH, Family Medicine and Community Health, University of Massachusetts - Worcester, 55 Lake Avenue North, Worcester, MA 01655.

The treatment of acute and chronic pain has recently come to the forefront as a medical care management issue and assessing pain is now a recommended “5th vital sign” (JCAHO, 2001). Chronic or persistent pain is one of the most common complaints of patients in primary care, and estimates of prevalence in the general population range from 14-46.5% (Blyth et al, 2001; Buskila et al, 2000; Elliott et al, 1999; Gureje, 1998; Hunt et al, 1999; Smith et al, 2001). Despite this growing body of multidisciplinary pain research, few studies have addressed the basic contextual challenges of providing primary care for chronic pain among diverse and disadvantaged populations. At the same time there is evidence that physicians assess and treat pain differently in minorities (Carey & Garrett, 2002). In addition, while active patient self-management premised on a good patient-physician relationship is key to treatment of chronic conditions, minority patients and those with less education have been found to view patient-centered care as less valuable (Krupat et al, 2001).

This study reports preliminary findings from a survey of primary care providers at five community health centers serving large free care and publicly insured patient populations (n=59). The survey explores attitudes of PCPs toward patients with chronic pain; satisfaction with pain education; satisfaction with care delivered; barriers to PCPs providing care, including health care barriers and patient barriers; and questions about common avenues of treatment. Overall, providers report limited satisfaction with their success in treating chronic pain (M=1.94, scale of 0-4) and in their medical training in this area (M=<1, scale of 0-2 for undergraduate and post-graduate education).

They rank 4 of the top 5 barriers to delivering good pain management as patient-related (psychological status, self management compliance, life style), while 4 of the 5 least problematic items were provider practice issues (lack of evidence-based guidelines, lack of time to monitor, diagnose, or assess properly). The most frequent barriers to opioid prescribing were noted as fear of patient addiction, and opportunity to sell the drugs, although ranked third was their own lack of knowledge about appropriate prescribing practices. Legal and systems issues were less frequently mentioned as barriers.

Providers reported frequently discussing life circumstances that could contribute to pain, but less frequently discussing goals with patients, or assessing realistic self-management options. Patient contracts, pain logs, and education were ranked as the least frequent techniques used to work with chronic pain patients.

Learning Objectives: At the conclusion of this session, participants will

• Identify key barriers to treatment of chronic pain in diverse and disadvantaged populations.
• Articulate provider education issues to improve patient-centered care.
• Develop interventions to improve chronic pain care in community settings.

Keywords: Urban Health Care, Quality of Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation