Interview with Nurse Practitioner About Patient Reported Outcomes
Health Helm’s CEO, Pamela McNamara, sat down with a Nurse Practitioner in a pain management practice in New England, to discuss patient centered care, patient reported outcomes, and how these could enable her patients to receive a more holistic approach to care.
What does patient centered care mean to you and your practice?
We follow the CDC guidelines and apply judgment given the risk factors. For example, we ask patients how long they have been on pain medications — opioid or others. We treat each patient holistically, considering her/his situation: How functional are they, are they working or disabled? What activities do they want to be doing with or without medication? What are they doing to avoid pain? What other medical considerations, such as social and mental health ailments are they affected by?
We consider and encourage trying alternatives to opioids for each patient, such as aquatic therapy for an osteoarthritis patient, chiropractic care for a younger patient, acupuncture, massage and/or yoga.We also attempt to use other pain management options including non-opioid prescription including over-the-counter aspirin, ibuprofen and acetaminophen, pain creams and patches. Medical cannabis including CBD creams and oils can be beneficial for chronic pain helping patients with anxiety, sleep and muscle spasms. We offer surgical procedures high-tech treatments using radio waves and electrical signals or implantable spinal cord stimulation. Unfortunately not all patients have access to these alternative therapies. Many of these therapies are not covered by insurance or these patients have access to care issues causing barriers to receiving this type of care.
How would a mobile patient reported outcomes tool fit in to your practice: supporting you as a clinician, while aiding in the treatment and management of your patients, as well as enabling them to better manage themselves?
A top priority for our patients is to gauge the extent to which they are trying to manage themselves and deal with their pain, and pain-related issues, rather than solely seeking more pain medications. If we know a patient is trying, we can work with them to utilize alternative approaches to opioids.
One benefit of patient reported outcome data will be to see evidence of how the patient is trying to manage their pain and with what result.
This patient reported outcome data can provide me, as a clinician, with a better basis for building an ongoing relationship with my patients to manage their pain and make progress.
Patient reporting would enable me to track their pain and other medication, track the extent and circumstances in which pain meds including what doses, numbers, and pills are being taken.
How would the PRO tracking work in your practice?
Typically we see a patient on chronic opiate therapy monthly. Patients on non opioids therapy are followed every three to six months.
During that four week period, we monitor their pain using pain scale tools. The use of a pain scale can help guide the clinician in creating a treatment plan as well as measure the effectiveness of the treatment. Indications a treatment plan may be ineffective include if a patient scores a 10 consistently (on the traditional pain scale of one to 10), the patient also reporting that they’re repeatedly out of medication early? The mobile tracking would help us monitor that more closely.
A mobile tool to monitor patient reported outcomes would be useful during the middle of that two month period, to alert us if problems are occurring. For other patients, patient reported outcome data is useful just before or during the four week follow-up visit to assess clinical status, progress, or problems, and to focus the patient visit on key issues. In preparation for this type of patient, the data would be scanned for sleep pattern variations, increased or decreased activity levels, issues related to ambulation, and responses to questions such as “ Do the current medication you are keep you functional and able to perform the daily tasks you need to do?”
The clinician would look at a snapshot for that patient over the prior month and be better prepared for a discussion about what’s going on, what can be changed in the pain management regimen, and what may need to change in other related activities.