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Family Medicine Physicians’ Views of How to Improve Chronic Pain Management

From the Department of Family Medicine and Community Health, University of Massachusetts Medical School, Boston

Correspondence: Corresponding author: Linda Garufi Clark, MD, Family Health Center of Worcester, 26 Queen Street, Worcester, MA 01610 (E-mail: Linda.ClarkFHCW{at}umassmed.edu)

Purpose: To determine family practice provider views of how to improve chronic nonmalignant pain (CNMP) management in primary care.

Methods: Modified Delphi group process with providers randomly selected from 6 community practice sites: 3 federally qualified community health centers, 1 rural health center, and 2 hospital-owned practices. Providers gave structured written feedback in response to a report of provider and patient concerns about the quality of CNMP in their practice sites and participated in a facilitated discussion in 1 of 3 group meetings.

Results: 54% participation (n = 14) of family physicians, 6 to 30 years out of residency, identified 4 major themes for improvement of CNMP treatment: (1) the need for provider practice guidelines; (2) changes in the monthly opioid prescription refill process; (3) provision of self-management support and access to alternative treatments for patients; and (4) the use of a nurse care manager.

Conclusions: Family physicians identified multiple components of practice that would improve both provider and patient experiences during and outcomes of CNMP management. Recommendations lend themselves to consideration of CNMP as a chronic illness and use of the Chronic Care Model as an appropriate framework for quality improvement.

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