Interventions Incorporating Interdisciplinary Teaming to Improve Chronic Pain Management in Primary Care: A Systematic Review

Abstract

Current chronic pain management recommendations emphasize leveraging interdisciplinary care models, which rely on communication, coordination, and collaboration among multiple providers. We aimed to identify key features of interdisciplinary teamwork and teaming processes that facilitate improved pain outcomes for patients experiencing chronic pain in primary care settings. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library for English language, randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (i.e. BPI total pain), include primary care as an intervention setting, and involve interactions between at least two providers and the patient over time. We assessed study quality with the Cochrane Risk of Bias tool. We qualitatively synthesized findings on intervention characteristics related to teamwork and teaming processes and patient pain outcomes. PROSPERO Registration: CRD42020191467. We included 13 randomized studies with 14 total interventions in our review, of which 7 reported one or more significantly improved pain outcome compared to controls over 6 to 12 months of observation. Most studies involved multiple primary care practices in the USA or Canada. Five studies were evaluated either within the Indianapolis Veterans Affairs Medical Center (VAMC) or the Portland VAMC. Other studies took place in primary care centers in Spain, Finland, the UK, and the Netherlands. Interventions with positive pain outcomes often described regularly scheduled patient contact, but there were few identified similarities about the communication, coordination, and collaboration processes among clinical intervention members. Care management and patient follow-up schedules were identified as key characteristics of teamwork or teaming in the interventions associated with improved pain outcomes. Despite widespread emphasis on interdisciplinary teams for pain management, high quality evidence about relevant team structures and teamwork and teaming processes remains limited. Care management and patient follow-up characterized primary care-based interventions involving teaming associated with improved pain outcomes.