Chronic pain management for older adults in ambulatory care : Results of a randomized pragmatic trial in Berlin, Germany.

Abstract

Chronic pain is a major health challenge in older populations and approaches to improve ambulatory care are urgently needed. We conducted a pragmatic trial to test whether staff-directed interventions can improve chronic pain management in older community-dwelling adults and thereby improve their pain situation. Participants of 22 ambulatory nursing services (clusters) were allocated to 3 study arms: I1 (individual intervention with recommendations for each participant's physician and a newly trained pain nurse), I2 (digital training offered for participants' physicians and nursing staff) and CG (control group). Survey-based face to face interviews were held at the participants' homes. Descriptive statistics, ANOVA, and χ²-tests were utilized for data analysis. At baseline, 190 and at follow-up 144 participants were analyzed (24% dropout). Overall, the interventions were only implemented by a small proportion of involved staff. We found significant changes in documented nursing care in I1 but improvements regarding pain medication appropriateness or pain situations of participants could not be achieved. Structural challenges like time and staff shortages as well as the lack of billing options in ambulatory care were identified as major obstacles to substantially improve pain care. Policy makers need to enable appropriate compensation models for chronic pain care at home to enable aging in place for a growing population of older adults.