2.50
Hdl Handle:
http://hdl.handle.net/10755/162462
Type:
Presentation
Title:
Reducing Utilization: An ED-Based Behavioral Health Chronic Pain Intervention
Abstract:
Reducing Utilization: An ED-Based Behavioral Health Chronic Pain Intervention
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Woodhouse, Jonathan, MA
P.I. Institution Name:George Fox University
Title:Clinical Psychology Doctoral Student
Contact Address:, Newberg, OR, 97132-, USA
Co-Authors:Julia S. Florea, RN, BSN, CCRN, CEN, CNA-BC; Mary Peterson, PhD; Clark Campbell, PhD; Kathleen Gathercoal, PhD
Purpose: An estimated 50 million Americans suffer from chronic pain, however, a minority of chronic pain patients consume a disproportionately large quantity of healthcare resources including emergency department (ED) services. Therefore, an ED-based, behavioral health intervention for chronic pain patients is needed to better serve this population, and to help hospitals provide cost effective treatment at the appropriate level of care. It was hypothesized that this intervention would reduce the high utilization of ED services by some chronic pain patients

Design: This study was a program evaluation utilizing a quasi-experimental, retrospective, pretest-posttest, split-plot design.

Setting: The setting was a 40-bed acute care hospital with a 15-bed Emergency Department seeing 16,500 patients annually.

Participants/Subjects: All participants were chronic pain patients utilizing the ED for pain management, were referred by their ED physician, were willing to participate, and established a 6-month pre-consultation baseline.

Methods: All subjects were seen in the ED by a clinical psychology doctoral student. The behavioral health consultation consisted of six parts: 1) Assessment via the Brief Pain Inventory, a fifteen question assessment instrument commonly used in pain management research and clinical work; 2) Psychoeducation introducing the biopsychosocial conceptualization of pain; 3) Emphasizing the primary care physician, via a disincentive gradient, as the appropriate level of care for medication management; 4) Referrals to a PCP were made as needed; 5) Adjunctive pain management referrals were made to an ED-based pain management group that met weekly; 6) Follow-up phone calls were made encouraging the subjects' participation in the pain management group, and their follow-through to contact their PCP.

Results: A repeated measures analysis of variance (ANOVA) was used to compare high-utilizers (> 4 ED visits in 6 months) to low-utilizers in total ED visits 6 months before and after the intervention. The low utilizers mean ED visits remained stable before and after the intervention (M=1.93, SD=.73 vs. M=1.5, SD=1.56, p >.05) while the high utilizers showed a decrease in ED utilization after the intervention (M=6.6, SD=2.20 vs. M=3.93, SD=3.15), which was statistically significant (p = <.05). This differential response between groups was statistically significant (p<.05).

Recommendations: This study shows that an ED-based behavioral health consultation may be a cost-effective adjunctive intervention that is efficacious in reducing the high utilization of ED services by some chronic pain patients, particularly those who consume the most services.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleReducing Utilization: An ED-Based Behavioral Health Chronic Pain Interventionen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162462-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Reducing Utilization: An ED-Based Behavioral Health Chronic Pain Intervention</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Woodhouse, Jonathan, MA</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">George Fox University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Psychology Doctoral Student</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Newberg, OR, 97132-, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jon.woodhouse@gmail.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Julia S. Florea, RN, BSN, CCRN, CEN, CNA-BC; Mary Peterson, PhD; Clark Campbell, PhD; Kathleen Gathercoal, PhD</td></tr><tr><td colspan="2" class="item-abstract">Purpose: An estimated 50 million Americans suffer from chronic pain, however, a minority of chronic pain patients consume a disproportionately large quantity of healthcare resources including emergency department (ED) services. Therefore, an ED-based, behavioral health intervention for chronic pain patients is needed to better serve this population, and to help hospitals provide cost effective treatment at the appropriate level of care. It was hypothesized that this intervention would reduce the high utilization of ED services by some chronic pain patients<br/><br/>Design: This study was a program evaluation utilizing a quasi-experimental, retrospective, pretest-posttest, split-plot design. <br/><br/>Setting: The setting was a 40-bed acute care hospital with a 15-bed Emergency Department seeing 16,500 patients annually. <br/><br/>Participants/Subjects: All participants were chronic pain patients utilizing the ED for pain management, were referred by their ED physician, were willing to participate, and established a 6-month pre-consultation baseline. <br/><br/>Methods: All subjects were seen in the ED by a clinical psychology doctoral student. The behavioral health consultation consisted of six parts: 1) Assessment via the Brief Pain Inventory, a fifteen question assessment instrument commonly used in pain management research and clinical work; 2) Psychoeducation introducing the biopsychosocial conceptualization of pain; 3) Emphasizing the primary care physician, via a disincentive gradient, as the appropriate level of care for medication management; 4) Referrals to a PCP were made as needed; 5) Adjunctive pain management referrals were made to an ED-based pain management group that met weekly; 6) Follow-up phone calls were made encouraging the subjects' participation in the pain management group, and their follow-through to contact their PCP. <br/><br/>Results: A repeated measures analysis of variance (ANOVA) was used to compare high-utilizers (&gt; 4 ED visits in 6 months) to low-utilizers in total ED visits 6 months before and after the intervention. The low utilizers mean ED visits remained stable before and after the intervention (M=1.93, SD=.73 vs. M=1.5, SD=1.56, p &gt;.05) while the high utilizers showed a decrease in ED utilization after the intervention (M=6.6, SD=2.20 vs. M=3.93, SD=3.15), which was statistically significant (p = &lt;.05). This differential response between groups was statistically significant (p&lt;.05). <br/><br/>Recommendations: This study shows that an ED-based behavioral health consultation may be a cost-effective adjunctive intervention that is efficacious in reducing the high utilization of ED services by some chronic pain patients, particularly those who consume the most services.</td></tr></table>en_GB
dc.date.available2011-10-27T10:28:37Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:37Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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