title: Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.
abstract: OBJECTIVE
  The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps.
  
  
  METHODS
  Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care.
  
  
  METHODS
  A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics.
  
  
  METHODS
  An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction.
  
  
  RESULTS
  In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services.
  
  
  CONCLUSIONS
  Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned.
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut, USA; Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: Dorflinger
authors.forename: Christopher
authors.initials: C
authors.lastname: Ruser
authors.forename: John
authors.initials: J
authors.lastname: Sellinger
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Edens
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
mesh_terms: D000554:Ambulatory Care Facilities; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D059408:Pain Management / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration*
keywords: Assessment; Pain; Primary Care; Systems-Based Care