| Management of chronic nonmalignant pain: a needs assessment in an internal medicine resident continuity clinic. | |
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MedLine Citation:
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PMID: 18837203 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: The authors hypothesized that Internal Medicine (IM) residents experience a lack of preparation, confidence, and reward when managing patients with chronic nonmalignant pain (CNMP) in their continuity clinic and that they exhibit deficiencies in CNMP management practices, particularly when opioids are prescribed. METHODS: As part of a quality improvement project in the IM resident continuity clinic, the authors performed a needs assessment through a self-administered resident questionnaire and a retrospective chart review. RESULTS: Fifty-seven percent of respondents rated their CNMP preparation as "fair" or "poor," 89 percent reported that their experience was "much less" or "somewhat less" rewarding than managing patients with other chronic conditions, and 58 percent reported that CNMP management "negatively" or "very negatively" affected their view of primary care as a career. Twenty-eight charts of patients receiving opioids during a 1-year study period were reviewed. Although residents were likely to document pain diagnoses (93 percent) and pain scores (82 percent) as well as utilize medication agreements (82 percent), they were less likely to document illicit substance use (39 percent), document legal history (32 percent), or obtain prior medical records (39 percent). Few urine drug screens were ordered (18 percent) and 25 percent of patients had fewer than four face-to-face visits during the year. DISCUSSION: The questionnaire indicated that IM residents lack preparation in managing CNMP, which results in lack of confidence and reward. The chart review revealed management practice deficiencies in risk assessment and prescription drug misuse monitoring. As a result, the authors have implemented curricular interventions, integrated a pain clinic within the continuity clinic, optimized residency program clinic scheduling, and developed tools for consistency in management practices. |
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Authors:
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Leanne M Yanni; Michael F Weaver; Betty A Johnson; Laura A Morgan; Sarah E Harrington; Jessica M Ketchum |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of opioid management Volume: 4 ISSN: 1551-7489 ISO Abbreviation: J Opioid Manag Publication Date: 2008 Jul-Aug |
Date Detail:
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Created Date: 2008-10-07 Completed Date: 2008-10-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101234523 Medline TA: J Opioid Manag Country: United States |
Other Details:
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Languages: eng Pagination: 201-11 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, Virginia Commonwealth University, Richmond, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Analgesics, Opioid
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adverse effects,
therapeutic use* Chronic Disease Clinical Competence Continuity of Patient Care* Education, Medical Female Guideline Adherence Humans Internal Medicine* / education Internship and Residency* Job Satisfaction Male Needs Assessment* Opioid-Related Disorders / diagnosis, etiology Pain / drug therapy* Pain Clinics* Pain Measurement Practice Guidelines as Topic Program Development Quality of Health Care* Questionnaires Retrospective Studies Risk Assessment Substance Abuse Detection |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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