Over the past year, we have had the great pleasure to interview over 100 primary care providers and pain specialists about their experiences and beliefs about chronic pain management and the role of long-term opioids. In the upcoming months, we will share some of our insights, stories and learnings from these interviews.
Our questions covered a wide range of topics and treatment approaches. In each interview, we asked the question: “What is the most important tool in improving chronic pain outcomes.?” Surprisingly, the answer was nearly unanimous: patient education.
In one sense this is not a startling answer. It has been generally recognized that patient education is a critical element of patient empowerment in chronic disease management. Most state medical boards as well as the CDC have very specific recommendations for patient education topics with respect to the use of long-term opioids.
During the interviews, we probed the details of education to better understand the amount of time, the topics, the consistency, and the providers' observed impact of patient education. Some of the areas we probed included details on opioid optimization techniques, opioid and benzodiazepine mortality and morbidity, pre-procedure preparation for optimal post op/rehab pain management and management of conditions like fibromyalgia and migraine where there are treatments known to be far more effective than opioids. As we got into the details, we were intrigued by many of the answers.
Building on the clear consensus on the positive impacts of education was overwhelming agreement that education is generally underutilized in primary care practice and not delivered in a consistent manner across providers in the group. If the power of education is widely understood, why would this be?
While the power of education is recognized for its great impact, there is also a general recognition of the overall lack of remuneration associated with education. Providers just don’t get paid very well for the amount of time it takes. This sentiment was echoed universally among our interview participants. Education takes time and the general feeling was that pain patients already took up more time than the provider was able to offer. Some providers were already managing chronic pain in separate encounters from patients’ other chronic problems in order to improve the time and financial balance. These providers also recognized that this approach limited the number of new patients they could accept into the practice. Some providers had relegated education to Advanced Practice Providers or other clinical staff, yet hadn’t provided any training, curriculum, or incentive for education. Universally, there was agreement that chronic pain and opioid education was one more thing to do that wasn’t well compensated and took a lot of time. Interestingly, for those that felt they were including patient education in every visit, times ranged from two to five minutes per visit. Most providers also described little to no documentation of the patient education in their clinical documentation.
Is the power of patient education, already recognized as an impactful patient treatment tool, relegated to the ideal instead of the norm because healthcare systems cannot align it with the business needs of most providers? We seem to have a good idea of what works yet we cannot seem to find a way to deliver it so we accept what we do as good enough. Certainly, there has to be a better way.
Stay tuned for how OPOS addresses this challenge…