Challenges to Teaming for Pain in Primary Care

With approximately 100 million adults in the United States currently living with chronic pain, effective pain assessment and management is an area of vital clinical and public health concern. The National Pain Strategy has recently called for renewed emphasis on "integrated, multimodal, and interdisciplinary" models of pain management, and integrated, interdisciplinary team-based approaches to chronic disease management are increasingly adopted in practices nationwide. Coordinated interdisciplinary care may improve outcomes and satisfaction with care for patients with chronic conditions. The Patient Centered Medical Home (PCMH) model of primary care has emerged in response to the systemic emphasis on interdisciplinary chronic disease management. PCMH represents a team-based approach intended to provide patients with a continuous, accessible, coordinated, high quality care experience. Implementation of the PCMH model, however, has seen varied success,, and has faced a variety of barriers. Chronic pain is as an example of a chronic condition that relies on care from multiple providers with diverse expertise and may pose coordination challenges for PCMH teams. Understanding providers' experiences and challenges with caring for patients with chronic pain in an interdisciplinary primary care team-based structure is important to help identify critical needs and opportunities for improvement. As part of preliminary efforts to develop a national randomized control trial for enhanced pain screening and assessment methods, we conducted exploratory focus groups with providers from the various disciplines involved in primary care based chronic pain assessment and management. We employed inductive qualitative methodologies to characterize the challenges to team based pain care that emerged.