Does screening for pain correspond to high quality care for veterans?
BACKGROUND
Routine numeric screening for pain is widely recommended, but its association with overall quality of pain care is unclear.


OBJECTIVE
To assess adherence to measures of pain management quality and identify associated patient and provider factors.


METHODS
A cross-sectional visit-based study.


METHODS
One hundred and forty adult VA outpatient primary care clinic patients reporting a numeric rating scale (NRS) of moderate to severe pain (four or more on a zero to ten scale). Seventy-seven providers completed a baseline survey regarding general pain management attitudes and a post-visit survey regarding management of 112 participating patients.


RESULTS
We used chart review to determine adherence to four validated process quality indicators (QIs) including noting pain presence, pain character, and pain control, and intensifying pharmacological intervention. The average NRS was 6.7. Seventy-three percent of charts noted the presence of pain, 13.9% the character, 23.6% the degree of control, and 15.3% increased pain medication prescription. Charts were more likely to include documentation of pain presence if providers agreed that "patients want me to ask about pain" and "pain can have negative consequences on patient's functioning". Charts were more likely to document character of pain if providers agreed that "patients are able to rate their pain". Patients with musculoskeletal pain were less likely to have chart documentation of character of pain.


CONCLUSIONS
Despite routine pain screening in VA, providers seldom documented elements considered important to evaluation and treatment of pain. Improving pain care may require attention to all aspects of pain management, not just screening.
Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA. lisa.zubkoff@va.gov
Lisa
L
Zubkoff
Karl A
KA
Lorenz
Andy B
AB
Lanto
Cathy D
CD
Sherbourne
Joy R
JR
Goebel
Peter A
PA
Glassman
Lisa R
LR
Shugarman
Lisa S
LS
Meredith
Steven M
SM
Asch
D000700:Analgesics / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010147:Pain Measurement; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D019984:Quality Indicators, Health Care
D000700:Analgesics