Management of chronic nonmalignant pain

A needs assessment in an internal medicine resident continuity clinic

Leanne M. Yanni, Michael F. Weaver, Betty A. Johnson, Laura A. Morgan, Sarah E. Harrington, Jessica M. Ketchum

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Introduction: The authors hypothesized that Internal Medicine (IM) residents experience a lack of preparation, confidence, and reward when managing patients with chronic nonmalignant pain (CNMP) in their continuity clinic and that they exhibit deficiencies in CNMP management practices, particularly when opioids are prescribed. Methods: As part of a quality improvement project in the IM resident continuity clinic, the authors performed a needs assessment through a self-administered resident questionnaire and a retrospective chart review. Results: Fifty-seven percent of respondents rated their CNMP preparation as "fair" or "poor," 89 percent reported that their experience was "much less" or "somewhat less" rewarding than managing patients with other chronic conditions, and 58 percent reported that CNMP management "negatively" or "very negatively" affected their view of primary care as a career. Twenty-eight charts of patients receiving opioids during a 1-year study period were reviewed. Although residents were likely to document pain diagnoses (93 percent) and pain scores (82 percent) as well as utilize medication agreements (82 percent), they were less likely to document illicit substance use (39 percent), document legal history (32 percent), or obtain prior medical records (39 percent). Few urine drug screens were ordered (18 percent) and 25 percent of patients had fewer than four face-to-face visits during the year. Discussion: The questionnaire indicated that IM residents lack preparation in managing CNMP, which results in lack of confidence and reward. The chart review revealed management practice deficiencies in risk assessment and prescription drug misuse monitoring. As a result, the authors have implemented curricular interventions, integrated a pain clinic within the continuity clinic, optimized residency program clinic scheduling, and developed tools for consistency in management practices.

Original languageEnglish (US)
Pages (from-to)201-211
Number of pages11
JournalJournal of Opioid Management
Volume4
Issue number4
StatePublished - Jul 1 2008

Fingerprint

Needs Assessment
Internal Medicine
Chronic Pain
Practice Management
Pain Management
Reward
Opioid Analgesics
Prescription Drug Misuse
Pain Clinics
Pain
Drug Monitoring
Internship and Residency
Quality Improvement
Medical Records
Primary Health Care
History
Urine
Pharmaceutical Preparations
Surveys and Questionnaires

Keywords

  • Chronic noncancer pain
  • Chronic nonmalignant pain
  • Internal medicine
  • Medical education

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Anesthesiology and Pain Medicine

Cite this

Yanni, L. M., Weaver, M. F., Johnson, B. A., Morgan, L. A., Harrington, S. E., & Ketchum, J. M. (2008). Management of chronic nonmalignant pain: A needs assessment in an internal medicine resident continuity clinic. Journal of Opioid Management, 4(4), 201-211.

Management of chronic nonmalignant pain : A needs assessment in an internal medicine resident continuity clinic. / Yanni, Leanne M.; Weaver, Michael F.; Johnson, Betty A.; Morgan, Laura A.; Harrington, Sarah E.; Ketchum, Jessica M.

In: Journal of Opioid Management, Vol. 4, No. 4, 01.07.2008, p. 201-211.

Research output: Contribution to journalArticle

Yanni, LM, Weaver, MF, Johnson, BA, Morgan, LA, Harrington, SE & Ketchum, JM 2008, 'Management of chronic nonmalignant pain: A needs assessment in an internal medicine resident continuity clinic', Journal of Opioid Management, vol. 4, no. 4, pp. 201-211.
Yanni LM, Weaver MF, Johnson BA, Morgan LA, Harrington SE, Ketchum JM. Management of chronic nonmalignant pain: A needs assessment in an internal medicine resident continuity clinic. Journal of Opioid Management. 2008 Jul 1;4(4):201-211.
Yanni, Leanne M. ; Weaver, Michael F. ; Johnson, Betty A. ; Morgan, Laura A. ; Harrington, Sarah E. ; Ketchum, Jessica M. / Management of chronic nonmalignant pain : A needs assessment in an internal medicine resident continuity clinic. In: Journal of Opioid Management. 2008 ; Vol. 4, No. 4. pp. 201-211.
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