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PCMH in primary care improves adherence to chronic pain guidelines

Implementation of the patient-centered medical home model in the primary care setting improves adherence to chronic pain guidelines and screening recommendations for chronic pain, according to data published in the Journal of the American Board of Family Medicine.

“Currently, over half of patients with [chronic pain] are cared for by PCPs,” Nancy Elder, MD, MSPH, of the department of family and community medicine at the University of Cincinnati, and colleagues wrote. “However, these providers find patients with [chronic pain] a challenge to assess and manage…. Recent health care reforms have focused on patient-centered medical home (PCMH) as a model to provide comprehensive primary care to patients.”

To determine whether PCMH recognition leads to higher rates of implementing key practice recommendations for chronic pain management in primary care, the researchers reviewed charts at 12 practices affiliated with the University of Cincinnati. Among the practices, three had achieved PCMH level 3 recognition prior to the study, five practices were in the application process for level 3 recognition, and four practices had no PCMH recognition at all.

The researchers reviewed 485 charts of a sample of patients who received chronic pain care from a total of 65 PCPs. Recommendations were abstracted and compared based on PCMH status.

According to the researchers, eight of the 10 key recommendations were documented more often in the prior and ongoing PCMH cohorts, including determining pain severity, function, psychosocial distress and substance abuse, and the use of structured instruments in such assessments. In addition, the researchers found fewer differences between the cohorts in the management of chronic opioids, with only the ongoing PCMH cohort having higher documentation for five of the seven recommendations, including conducting urine drug screens, and using a structured instrument to determine misuse.

“We found that PCMH-recognized practices and practices in the process of obtaining PCMH recognition had higher rates of documenting key practice [chronic pain] recommendations,” Elder and colleagues wrote. “There findings suggest the usefulness of the PCMH model in managing patients with [chronic pain].” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.