ArticleJournal of general internal medicine2014
A partnered approach to opioid management, guideline concordant care and the stepped care model of pain management.
Article in Journal of general internal medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Effect of Opioid Stewardship Interventions on Key Outcomes: A Systematic Review.Journal of patient safety · 2020Pooled it
- Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Pain: a Rapid Evidence Review.Journal of general internal medicine · 2018Pooled it
- Co-Design for Developing and Integrating a Model of Care for Pain Management Centers: Protocol for a Biphase Qualitative Study.JMIR research protocols · 2025Article
- Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting.BMJ open quality · 2024Article
- Use of the knowledge to action model improved physical therapist adherence to a common clinical practice guideline across multiple settings: a multisite case series.BMC health services research · 2022Article
- Characteristics and productivity of the chiropractic workforce of the Veterans Health Administration.Chiropractic & manual therapies · 2022Article
- The relationship between capacity and utilization of nonpharmacologic therapies in the US Military Health System.BMC health services research · 2022Article
- Impact of a Vendor-Developed Opioid Clinical Decision Support Intervention on Adherence to Prescribing Guidelines, Opioid Prescribing, and Rates of Opioid-Related Encounters.Applied clinical informatics · 2022Article
- Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults.Pain management nursing : official journal of the American Society of Pain Management Nurses · 2021Article
- ICD-10 Coding of Musculoskeletal Conditions in the Veterans Health Administration.Pain medicine (Malden, Mass.) · 2021Article
- A Comprehensive, Multimodal, Interdisciplinary Approach to Chronic Non-Cancer Pain Management in a Family Medicine Clinic: A Retrospective Cohort Review.The Permanente journal · 2021Article
- When boundaries blur - exploring healthcare providers' views of chiropractic interprofessional care and the Canadian Forces Health Services.The Journal of the Canadian Chiropractic Association · 2021Article
- Article
- A Typology of New Long-term Opioid Prescribing in the Veterans Health Administration.Journal of general internal medicine · 2020Article
- Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices.Implementation science communications · 2020Article
- NIH-DoD-VA Pain Management Collaboratory.Pain medicine (Malden, Mass.) · 2019Article
- Patient Experiences With Integrated Pain Care: A Qualitative Evaluation of One VA's Biopsychosocial Approach to Chronic Pain Treatment and Opioid Safety.Global advances in health and medicine · 2019Article
- Dual Use of Department of Veterans Affairs and Medicare Benefits on High-Risk Opioid Prescriptions in Veterans Aged 65 Years and Older: Insights from the VA Musculoskeletal Disorders Cohort.Health services research · 2018Article
- Association Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy.Journal of general internal medicine · 2018Article
- Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain.Journal of general internal medicine · 2018Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPain is the most common presenting problem in primary care. Opioid therapy (OT) for chronic pain has increased dramatically over the past decade, as have related negative outcomes. Despite the development and dissemination of policy and clinical practice guidelines for pain management and OT, adoption has been variable. The Veterans Health Administration (VHA) has established a Stepped Care Model of Pain Management (SCM-PM) as an evidence-based framework and single standard of pain care to promote guideline-concordant care, but to date its adoption and related outcomes have not been systematically examined.
objectiveOur aim was to examine changes in care for Veterans receiving long-term OT for management of chronic pain over a four-year study period.
designAs part of a comprehensive implementation evaluation of performance improvements, the current evaluation reports performance improvement outcomes related to pain management and OT over a four-year period. SUBJECTS: We studied Veterans receiving long-term (90+ consecutive days) OT through primary care.
interventionsWe engaged an interdisciplinary clinical-research team to develop and implement a multifaceted performance improvement approach that included interactive educational strategies and other organizational initiatives. MAIN MEASURES: We measured the proportion of patients receiving long-term OT; use of opioid risk mitigation strategies; referrals to pain-related specialty services; and use of non-opioid analgesics. KEY
resultsThe proportion of patients receiving high-dose opioids decreased over four years (27.7 % to 24.7 %). The use of opioid risk mitigation strategies increased significantly. Referrals to physical therapy and chiropractic care and prescriptions for topical analgesics increased significantly, while referrals to the pain medicine specialty clinic decreased.
conclusionsWe demonstrate improvements in the management of veterans receiving OT that are consistent with the SCM-PM and published practice guidelines. We highlight how partnerships among funders, researchers, clinicians, and administrators contributed to the project's design and implementation, and to the dissemination strategy and future directions for improving opioid management and pain care.
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Registered trials
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