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Factors associated with participation and nonparticipation in a VA Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP)

Amber Martinson, PhD, Amanda Kutz, PhD, William Marchand, MD, Julie Carney, RN, Jamie Clinton-Lont, MS, CNP

Abstract


Objective: As part of the evaluation of the Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP), we compared demographic and health characteristics between participants and nonparticipants drawn from the same defined population.

Design/Methods: Retrospective chart review comparing participants and nonparticipants in terms of two categories of variables: (1) demographic characteristics and (2) physical/mental health characteristics.

Setting: VA Primary Care.

Subjects: Adult veterans with chronic noncancer pain receiving opioid therapy >3 months being managed in primary care.

Results: A total of 749 veterans (424 participants in PC-POP and 325 nonparticipants) were included in the final analysis. Results showed that nonparticipation was associated with more widespread musculoskeletal pain, low back pain, anxiety, higher mortality, and rural areas. Participation was associated with more medical diagnoses overall, hypertension, sleep apnea, fibromyalgia, peripheral nerve pain, depression, and female gender. Other demographic and physical/mental health variables did not significantly differ between the groups.

Conclusions: Given that primary care is the dominant healthcare setting in which opioids are prescribed for chronic noncancer pain, programs are needed to assist primary care providers to meet the rigorous requirements of guideline concordant care. The current study examined participation factors in such a program and found that certain veterans were less likely to participate than others. Identifying such veterans at the outset, in combination with intentional recruitment efforts and individualized interventions, may promote entry into PC-POP.


Keywords


participation factors, chronic pain, opioid therapy, primary care

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References


Gaudet T, Kligler B: Whole health in the whole system of the veterans administration: How will we know we have reached this future state? J Altern Complement Med. 2019; 25(S1): S7-S11.

Kerns RD, Otis JD, Wise, E: Treating families of chronic pain patients: application of a cognitive-behavioral transactional model. In: Gatchel RJ, Trk DC (eds.). Psychological approaches to pain management, 2nd ed. New York: Guilford Press; 2002: 256-275.

Otis JD, Gregor K, Hardway C, et al.: An examination of the co-morbidity between chronic pain and posttraumatic stress disorder on U.S. veterans. Psychol Serv. 2010; 7:126-135.

Gallagher RM: Advancing the pain agenda in the veteran population. Anesthesiol Clin. 2016; 34(2): 357-378.

Kaur S, Stechuchak KM, Coffman CJ, Allen KD: Gender differences in health care utilization among veterans with chronic pain. J Gen Intern Med. 2007; 22(2): 228-233.

Bohnert AS, Ilgen MA, Galea S, et al.: Accidental poisoning mortality among patients in the Department of Veterans Affairs Health System. Med Care. 2011; 49: 393-396.

Breuer B, Cruciani R, Portenoy R: Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: A national survey. South Med J. 2010; 103, 738-747.

Smith B, Elliott A, Hannaford P: Is chronic pain a distinct diagnosis in primary care? Evidence arising from the royal college of general practitioners--oral contraception study. Fam Pract. 2004; 21, 66-74.

American Academy of Family Physicians: Primary care. 2015. Available at http://www.aafp.org/about/policies/all/primarycare.html. Accessed August 4, 2019.

Johnson M, Collett B, Castro-Lopes JM: The challenges of pain management in primary care: A pan-European survey. J Pain Res. 2013; 6: 393.

Commission on Combating Drug Addiction and the Opioid Crisis: Interim draft report to the President. Available at https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf. Accessed August 1, 2017.

Comprehensive Addiction and Recovery Act (CARA). Public Law 114, Sec. 524. 2016.

Department of Veterans Affairs/Department of Defense (VA/DoD): VA/DoD Clinical Practice Guidelines for opioid therapy for chronic pain. 2017. Available at https://static1.squarespace.com/static/54d50ceee4b05797b34869cf/t/58abad0d1e5b6c62a4b71101/1487645971273/VADoDOTCPG021517clean.pdf. Accessed August 4, 2019.

Sekhon R, Aminjavahery N, Davis CN, Jr, et al.: Compliance with opioid treatment guidelines for chronic non-cancer pain (CNCP) in primary care at a Veterans Affairs Medical Center (VAMC). Pain Med. 2013; 14(10): 1548-1556.

Wu PC, Lang C, Hasson N, et al.: Opioid use in young veterans. J Opioid Manage. 2010; 6(2): 133-139.

Lockett TL, Hickman KL, Fils-Guerrier BJ, et al.: Opioid overdose and naloxone kit distribution: A quality assurance educational program in the primary care setting. J Addictions Nurs. 2018; 29(3): 157-162.

Starrels JL, Becker WC, Weiner MG, et al.: Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain. JGIM. 2011; 2; 958-964.

Clinton-Lont J, Kaye C, Martinson A: A primary care approach to managing chronic noncancer pain. Federal Pract. 2016; 33(12): 65-71.

Heinzelmann E, Bagley RW: Response to physical activity programs and their effects on health behavior. Public Health Rep. 1970; 85: 905-911.

West A, Weeks WB: Health care expenditures for urban and rural veterans in Veterans Health Administration care. Health Serv Res. 2009; 44(5 Pt 1): 1718-1734.

Weeks WB, Bott DM, Lamkin R, et al.: Veterans Health Administration and Medicare outpatient health care utilization by older rural and urban New England veterans. J Rural Health. 2005; 21(2):167-171.

Buzza C, Ono SS, Turvey C, et al.: Distance is relative: Unpacking a principal barrier in rural healthcare. J Gen Intern Med. 2011; 26(Suppl 2): 648-654.

French DD, Bradham DD, Campbell RR, et al.: Factors associated with program utilization of radiation therapy treatment for VHA and Medicare dually enrolled patients. J Commun Health. 2012; 37(4): 882-887.

Nayar P, Yu F, Apenteng B: Improving care for rural veterans: Are high dual users different? J Rural Health. 2014; 30(2): 139-145.

West A, Weeks WB: Physical and mental health and access to care among nonmetropolitan Veterans Health Administration patients under 65. J Rural Health. 2006; 22(1):9-16.

Kracen AC, Mastnak JM, Loaiza KA, et al.: Group therapy among OEF/OIF veterans: Treatment barriers and preferences. Mil Med. 2013; 178(1): 146-149.

Seal KH, Metzler TJ, Gima KS, et al.: Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. Am J Public Health. 2009; 99(9): 1651-1658.

Weiner DK, Kim YS, Bonino P, et al.: Low back pain in older adults: Are we utilizing healthcare resources wisely? Pain Med. 2006; 7: 143-150.

Dowell D, Haegerich TM, Chou R: CDC Guidelines for prescribing opioids for chronic pain-United States. MMWR Recomm Rep. 2016; 65: 1-49.




DOI: https://doi.org/10.5055/jom.2020.0566

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