The COVID-19 pandemic contributed to the widespread disruption of health care delivery and prevention, which may impact on those living with chronic pain. Effective treatment strategies for pain management can help avoid unnecessary emergency room visits and limit strain on the health care system, supporting the goal of reducing risk for frontline providers and vulnerable patients.
Given the current situation, providers in surgical and primary care settings should perform a thorough assessment of their pain management approach. Outlined below are best practices that can help organizations ensure that they are effectively treating pain, while optimizing access to care during the COVID-19 outbreak.
Provide Patient Engagement Through Communication and Education
With treatment challenges exacerbated by the pandemic, patient-centric pain management is more important than ever. Effective communication can enable patients to fully participate with providers to maintain their own health and make informed decisions.
Today’s environment limits in-person care, therefore providers must increase and improve communication to avoid gaps in care when conducting telemedicine, and adequately account for patient variability when developing individualized treatment plans.
Clinicians should also set realistic expectations about the treatment plan and discuss health literacy, shared decision making, and necessary lifestyle changes to increase patients’ skills and confidence in managing their pain problems. At all times, it is important to help patients determine alternative options for their self-care. Many patients, for example, may not be able to attend physical therapy sessions to help manage pain, making it important to encourage continued movement and offer adapted exercise options.
Implement Opioid Stewardship
While circumstances may vary in the prescribing of opioids in primary care versus surgical settings, the recommendations for safe prescribing are similar. Importantly, physicians must understand the causes behind chronic opioid use and overdose and use research-based guidelines to prescribe safer dosages.
To guide safer prescribing practices, several state programs and insurance companies have requirements for health care providers. For example, many providers must enroll in and use a prescription monitoring program to better understand existing opioid prescriptions/use, discuss the addictive nature of opioids with patients, and/or obtain prior authorization for prescribing opioids.
To help providers navigate these pain management challenges, the Accreditation Association for Ambulatory Health Care (AAAHC) recently released its Pain Management Toolkit, which addresses key factors for opioid stewardship, including pain assessment and function, calculating safe dosages, and prescribing. Discussing both the management of chronic pain and acute surgical- or procedural-related pain, the toolkit can be used to help drive quality improvement in both surgical and primary care practices.
Prioritize Function
The primary aim of pain management is not to achieve a certain pain score but to improve post-operative function and allow rehabilitation, while maintaining patient comfort. Abundant evidence shows that rehabilitation in conjunction with pain control can result in further improvements in patients' function, such as activities of daily living (ADL) and quality of life.
Since there is no completely objective way to describe or measure pain, clinicians use measures of function to grade pain severity. Therefore, functional restoration requires finding out what ADLs have been impaired and how they have improved (or not) using validated questionnaires for physical function and psychological condition. When possible, providers also use direct measurements of focal and general function, such as evaluating the patient’s ability to walk after lower extremity surgery.
Whether providing pain management in a surgical or primary care practice, patient re-evaluation is critical to ensuring that the patient is mobile and able to return to normal functions, as well as prevent medication dependency or overdose. The standardization of patient monitoring, follow-up, and re-evaluation is critical in both settings.
Apply Quality Improvement (QI) to Pain Management
The prevalence of pain among patients is a serious issue that all ambulatory organizations can help address with the right focus and adherence to ongoing performance measurement. As part of the QI process, health care providers should
- Continuously assess their pain management approaches and opioid prescribing practices using research literature and other resources as external benchmarks,
- Compare their performance against both external benchmarks described above and internal benchmarks, such as peer data.
- Develop a QI study where improvement is indicated that includes setting a quantitative goal, collecting and analyzing data, comparing the findings to the goal, implementing corrective actions and remeasurement until goal is achieved, and communicating study results to their governing body and throughout the organization.
Accreditation can help an organization achieve a QI mindset through a process that strengthens relationships with staff and recommits care teams to practices that deliver improved patient outcomes. AAAHC offers a collaborative accreditation model built on a personal, consultative survey process that aligns with its 1095 Strong, quality every day philosophy, providing research-based recommendations and educational resources to help providers consistently improve throughout the 1,095 days of the accreditation term.
AAAHC Accreditation continues to provide a heightened focus on infectious disease protocols, such as policies and processes for mitigating the risk of spreading infection and treating pain patients remotely. The accreditation process can help guide a health care facility through a productive assessment of their pain management strategies to ensure best practices during the evolving COVID-19 pandemic.
In November, AAAHC will be hosting a webinar series Medication Management on the following topics: Allergy Documentation, Medication Reconciliation, and Pain Management.
To learn more and register, visit http://www.aaahc.org/education/1095-learn/. To order the pain management toolkit, click here or visit https://www.aaahc.org/quality/.