Medical group visits: a feasibility study to manage patients with chronic pain in an underserved urban clinic

Paula Gardiner, Danielle Dresner, Katherine Gergen Barnett, Ekaterina Sadikova, Robert Saper, Paula Gardiner, Danielle Dresner, Katherine Gergen Barnett, Ekaterina Sadikova, Robert Saper

Abstract

Background: Chronic pain affects millions of racially diverse Americans. Evidence suggests that group medical visits are effective for treating chronic pain; similarly, a number of studies demonstrate the effectiveness of certain evidence-based complementary therapies in managing pain.

Objectives: The primary goal of this study is to evaluate the feasibility of the integrative medical group visit (IMGV) care model in an inner-city racially diverse outpatient clinic. IMGV combines patient-centered, non-pharmacologic strategies and principles of mindfulness-based stress-reduction with a group medical visit to reduce pain and associated symptoms.

Methods: We surveyed patients pre and post an 8-session IMGV program to evaluate changes in pain in the last week (0-10 point scale) and comorbid symptoms including depression (Patient Health Questionaire-8 [PHQ-8]), perceived stress, and sleep quality. We also recorded referrals to the program, patients screened for eligibility, total enrollment, loss to follow-up, and attendance.

Results: Seventy patients joined IMGV, and of these, 65 (93%) enrolled in the study. Over the course of 12 months, 7 groups met (median 9 patients/group; range 8-13 participants). Mean difference in pain level for all patients between baseline and 8 weeks was 0.7 (SD=2.0, P=.005). Mean difference in PHQ-8 depression score for patients with baseline score ≥5 was 2.6 (SD=4.6, P<.001). Statistically significant improvements were also seen in sleep quality and perceived stress.

Conclusion: A group visits program combining conventional and integrative medicine for predominantly racially diverse patients is feasible.

Keywords: Group medical visit; chronic pain; integrative medical group visits; mindfulness-based stress reduction; patient-centered non-pharmacologic strategies.

Figures

Figure
Figure
Boston Medical Center Integrative Medical Group Visits: the merger of three paradigms.

References

    1. Relieving pain in America: a blueprint for transforming prevention, care, education and research. Institute of Medicine. 2011. AccessedJune18, 2013
    1. Green CR, Anderson KO, Baker TAet al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003; 4(3): 277–94
    1. Upshur CC, Luckmann RS, Savageau JA.Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006; 21(6): 652–5
    1. Gaynor CH, Vincent C, Safranek Set al. FPIN's clinical inquiries. Group medical visits for the management of chronic pain. Am Fam Physician. 2007; 76(11): 1704–5
    1. Jaber R, Braksmajer A, Trilling JS.Group visits: a qualitative review of current research. J Am Board Fam Med. 2006; 19(3): 276–290
    1. Wagner EH, Grothaus LC, Sandhu Net al. Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care. 2001; 24(4): 695–700
    1. Clancy DE, Brown SB, Magruder KMet al. Group visits in medically and economically disadvantaged patients with type 2 diabetes and their relationships to clinical outcomes. Top Health Inf Manage. 2003; 24(1): 8–14
    1. Sadur CN, Moline N, Costa Met al. Diabetes management in a health maintenance organization: Efficacy of care management using cluster visits. Diabetes Care. 1999; 22(12): 2011–7
    1. Rosenzweig S, Greeson JM, Reibel DKet al. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010; 68(1): 29–36
    1. Kabat-Zinn J, Lipworth L, Burney R.The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985; 8(2): 163–90
    1. Kabat-Zinn J.Mindfulness-based interventions in context: past, present, and future. Clin Psychol Sci Pr. 2003; 10(2): 144–56
    1. Fjorback LO, Arendt M, Ornbøl Eet al. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatr Scand. 2011; 124(2): 102–19
    1. Calonge N.Primary care interventions to prevent low back pain in adults. Agency for Healthcare Research and Quality; 2004. AccessedJune3, 2014
    1. Chou R, Huffman LH.American Pain Society, American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007; 147(7): 492–504
    1. Cherkin DC, Eisenberg D, Sherman KJet al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 2001; 161(8): 1081–8
    1. Manheimer E, White A, Berman Bet al. Meta-analysis: acupuncture for low back pain. Ann Intern Med. 2005; 142(8): 651–63
    1. Sherman KJ, Cherkin DC, Wellman RDet al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011; 171(22): 2019–26
    1. Cherkin DC, Sherman KJ, Kahn Jet al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011; 155(1): 1–9
    1. National Center for Complementary and Alternative Medicine. The use of complementary and alternative medicine in the United States. AccessedJune3, 2014
    1. Khorsan R, Coulter ID, Crawford Cet al. Systematic review of integrative health care research: Randomized control trials, clinical controlled trials, and meta-analysis. Evid-Based Complement Altern Med. 2011; doi:
    1. Bradley R, Max S.Food user manual volume 1: an introduction. Seattle, WA: Ryan Bradley and Sonja Max; 2012
    1. Von Korff M, Jensen MP, Karoly P.Assessing global pain severity by self-report in clinical and health services research. Spine. 2000; 25(24): 3140–51
    1. Ritter PL, González VM, Laurent DDet al. Measurement of pain using the visual numeric scale. J Rheumatol. 2006; 33(3): 574–80
    1. Kroenke K, Strine TW, Spitzer RLet al. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009; 114(1-3): 163–73.doi:
    1. Buysse DJ, Reynolds CF, Monk THet al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2): 193–213
    1. Hewitt PL, Flett GL, Mosher SW.The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample. J Psychopathol Behav Assess. 1992; 14(3): 247–57.doi:
    1. Cohen S, Kamarck T, Mermelstein R.A global measure of perceived stress. J Health Soc Behav. 1983; 24(4): 385–96
    1. Spitzer RL, Kroenke K, Williams JBWet al. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med. 2006; 166(10): 1092–1097.doi:
    1. Kirsh S, Watts S, Pascuzzi Ket al. Shared medical appointments based on the chronic care model: a quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk. Qual Saf Health Care. 2007; 16(5): 349–53.doi:
    1. Trento M, Passera P, Bajardi Met al. Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial. Diabetologia. 2002; 45(9): 1231–9.doi:
    1. Riley SB, Marshall ES.Group visits in diabetes care: a systematic review. Diabetes Educ. 2010; 36(6): 936–44.doi:
    1. Clancy DE, Huang P, Okonofua Eet al. Group visits: Promoting adherence to diabetes guidelines. J Gen Intern Med. 2007; 22(5): 620–4.doi:
    1. Scott JC, Conner DA, Venohr Iet al. Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: A 2-Year randomized trial of the cooperative health care clinic. J Am Geriatr Soc. 2004; 52(9): 1463–70.doi:
    1. Beck A, Scott J, Williams Pet al. A randomized trial of group outpatient visits for chronically ill older HMO members: the cooperative health care clinic. J Am Geriatr Soc. 1997; 45(5): 543–9
    1. Geller JS, Orkaby A, Cleghorn GD.Impact of a group medical visit program on Latino health-related quality of life. Explore J Sci Heal. 2011; 7(2): 94–9.doi:
    1. Cramer H, Lauche R, Haller Het al. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013; 29(5): 450–60.doi:
    1. Berman BM, Lao L, Langenberg Pet al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004; 141(12): 901–10
    1. Cherkin DC, Sherman KJ, Kahn Jet al. Effectiveness of focused structural massage and relaxation massage for chronic low back pain: protocol for a randomized controlled trial. Trials. 2009; 10: 96 doi:

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera