Patient engagement and prescription opioid use in perioperative pain management

Abstract

Objective: To examine (1) patient perceptions regarding their engagement and the engagement of their families in perioperative pain management, (2) demographic and clinical characteristics associated with perceived patient and family engagement, and (3) the association between perceived patient and family engagement and patient outcomes.Design: A prospective, observational study. Setting: The Personalized Pain Program (PPP) at the Johns Hopkins Hospital in Baltimore, Maryland.Participants: Patients having more than one visit to the PPP.Interventions: n/a.Main outcome measures: Since the inception of the PPP, patients were surveyed prior to each clinic visit to assess their pain severity and interference using the Brief Pain Inventory. Starting August 22, 2018, two additional questions were added to the survey to assess patient perceptions of their engagement and the engagement of their families in perioperative pain management. In addition, electronic medical records were reviewed to collect data on daily opioid consumption during the first and last PPP visits presurgery and post-surgery. Results: The final analysis included 511 survey responses from 155 patients. Perceived engagement of the patient in perioperative pain management improved over time (p .001) and was significantly associated with reduction in prescription opioid consumption after surgery (coef = 12.7, SE = 5.8, p = .031).Conclusions: Surgical patients and their family members should be actively engaged in perioperative pain management to improve prescription opioid use and the quality and safety of perioperative care.

Patient Experiences and Clinical Outcomes in a Multidisciplinary Perioperative Transitional Pain Service

“…A total of 20% of respondents were African American, 73% were unemployed or disabled, and 54% were married. In comparison, 37% of the PPP population are African American, 60% are unemployed or disabled, and 36% are married [35]. While approximately 25% of the clinic's total population had seen the clinic psychiatrist, most respondents in this study (54%) received psychiatric co-treatment.…”

“…The study was conducted at the PPP, a multidisciplinary transitional perioperative pain service at The Johns Hopkins Hospital in Baltimore, Maryland. A summary of the clinical workflow and outcomes of the PPP has been described previously [34,35]. Briefly, patients eligible for the PPP are surgical candidates on preoperative opioids, opioid-naïve participants at risk of chronic opioid therapy after surgery (e.g., surgery severity, high-dose MME at discharge, psychiatric comorbidities), or patients with a current or past history of OUD.…”

“…The Johns Hopkins Personalized Pain Program (PPP) is a transitional perioperative pain service offering specialized pain management and concurrent psychiatric treatment for patients with preoperative pain and opioid use or those at risk of long-term opioid therapy [26]. Consistent with findings from other institutions [30][31][32][33], the PPP has shown success in facilitating reductions of postoperative opioid consumption with concurrent improvements in clinical outcomes [34][35][36]. Collectively, these data evidence that long-term, multidisciplinary, coordinated pain management adds healthcare value for surgical patients at greatest risk of chronic pain and high-dose long-term opioid use.…”

The Personalized Pain Program: A New Transitional Perioperative Pain Care Delivery Model to Improve Surgical Recovery and Address the Opioid Crisis

“…Engaging surgical patients in perioperative pain management is essential to optimize recovery, and patients are encouraged to work with their clinicians to identify treatment goals and successfully manage pain using current, safe, and effective treatments. We have shown that perceived engagement in pain management is significantly associated with reduction in prescription opioid use after surgery 7…”

“…We have shown that perceived engagement in pain management is significantly associated with reduction in prescription opioid use after surgery. 7 To improve patient engagement in the PPP, we applied a human factors and systems engineering approach to develop a multifaceted intervention including (1) a patient navigation tool for patients to document their pain experience and prepare for their PPP visits, (2) a PPP website with instruction videos to introduce the PPP and multimodal analgesic regimen to patients, and (3) a PPP brochure to provide current PPP information to both referring clinicians and potential patients. Both PPP patients and clinicians believed that the intervention was easy to use and has the potential to improve patient engagement by facilitating information sharing between patients and clinicians and empowering patients to work with their clinicians to set goals and develop plans for their treatment.…”