Identifying Strategies to Improve Implementation of Integrative Pain Management in Primary Care.

Abstract

Background: Mounting evidence supports the use of integrative pain management (IPM) in primary care settings. There is limited understanding of primary care clinicians' experiences, recommendations, and strategies for integrating IPM into clinical care.

Methods: A total of 97 clinicians were contacted via e-mail from a listserv maintained by the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region Practice and Research Network, a practice-based research network. A total of 23 clinicians completed a recruitment survey and 21 were contacted to schedule an in-depth interview. Interviews addressed knowledge of and approaches to IPM, barriers and facilitators integrating IPM into clinical care, and recommendations for future program design. Interviews were completed until saturation was reached and then were transcribed and subjected to thematic analysis. Participants were offered $100 for their participation in the interview.

Results: A total of 14 clinicians included 11 MDs, 1 PA, 1 LCSW, and 1 PharmD. Domains reported include strategies and perspectives on integrating IPM, system level improvements needed to increase access, clinical barriers to addressing chronic pain, and perceived patient level challenges. Key findings within these domains include the need for a paradigm shift in the approach to treating chronic pain, the importance of adaptability and flexibility, and challenges related to time, payment, and resource availability.

Discussion: As a specialty that focuses on whole-person, comprehensive care, family medicine is uniquely situated to integrate IPM into routine practice. Furthermore, ongoing collaboration with primary care clinicians such as behavioral health providers and pharmacists are synergistic toward these goals. However, challenges related to knowledge, comfort, payment, and resource availability must first be overcome within family medicine. This requires improving education on pain management in medical school and residency, increasing access to community referral networks with specialized knowledge in chronic pain, and expanding payments for nonpharmacologic and team-based care.