Abstract
Although pain is among the most common symptoms reported by patients, primary care practitioners (PCPs) face substantial challenges identifying and assessing pain. To evaluate a 2-step process for chronic pain screening and follow-up in primary care. A cross-sectional study of patients with a primary care visit between July 2, 2018, and June 1, 2019, was conducted at a statewide, multisite federally qualified health center. Participants included 68 PCPs and 58 medical assistants from 13 sites who implemented the screening process in primary care, and 38 866 patients aged 18 years or older with a primary care visit during that time. Single-question assessment of pain frequency, followed by a 3-question PEG (pain, enjoyment of life, general activity) functional assessment for patients with chronic pain. Adherence to a 2-step chronic pain screening and PEG process, proportion of patients with positive screening results, mean PEG pain severity greater than or equal to 7, and documented chronic painful condition diagnosis in patient's electronic health record between 1 year before and 90 days after screening. Of 38 866 patients with a primary care visit, 31 600 patients (81.3%) underwent screening. Mean (SD) age was 46.2 (15.4) years, and most were aged 35 to 54 years (12 987 [41.1%]), female (18 436 [58.3%]), Hispanic (14 809 [46.9%]), and English-speaking (22 519 [71.3%]), and had Medicaid insurance (18 442 [58.4%]). A total of 10 262 participants (32.5%) screened positive and, of these, 9701 (94.5%) completed the PEG questionnaire. PEG responses indicated severe pain interference with activities of daily living (PEG ≥7) in 5735 (59.1%) participants. A chronic painful condition had not been diagnosed in 4257 (43.9%) patients in the year before screening. A new chronic painful condition was diagnosed at screening or within 90 days in 2250 (52.9%) patients. Care teams found the workflow acceptable, but cited lengthy administration time, challenges with comprehension of the PEG questions, and limited comprehensiveness as implementation barriers. A systematic, 2-step process for chronic pain screening and functional assessment in primary care appeared to identify patients with previously undocumented chronic pain and was feasible to implement. Patient-provided information on the frequency of pain, pain level, and pain interference can help improve the assessment and monitoring of pain in primary care.
Highlights
Chronic pain is a leading cause of disability and one of the most common reasons for seeking medical care.[1,2] In 2016, approximately 50 million US adults (20.4% of the population) experienced chronic pain and 8.0% experienced high-impact chronic pain that limited work or other life activities.[1]
Meaning The findings of this study suggest that implementing this measure for chronic pain screening and functional assessment might provide additional clinical information on patients’ pain experience
Severe chronic pain[7] disproportionately affects medically underserved patients,[8] including those with low socioeconomic status, less than a high school educational level, and Medicaid health insurance.[1]. These patients have increased vulnerability to chronic pain[1,9] and may experience diminished quality of care[10,11] owing to limited access to treatment,[12,13] misunderstanding or misinterpretation of pain severity, and misaligned expectations between patients and health care professionals about pain treatment, function, and quality of life.[14,15]. These factors are relevant in Federally Qualified Health Centers (FQHCs), which provide primary care to approximately 28 million medically underserved patients in the US,[16] including a high proportion of racial and ethnic minority groups.[17]
Summary
Chronic pain is a leading cause of disability and one of the most common reasons for seeking medical care.[1,2] In 2016, approximately 50 million US adults (20.4% of the population) experienced chronic pain and 8.0% experienced high-impact chronic pain that limited work or other life activities.[1]. Pain care delivered at FQHCs is subject to the same quality standards as primary care in other settings,[18] but FQHC care teams must contend with limitations in staffing and other resources as well as diminished access to recommended treatment modalities.[19,20]
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