Helping Primary Care Physicians Provide Safe, Comprehensive Pain Management to Older Adults

Overview

Primary care physicians (PCPs) and their teams are lifelines for aging patients. These patients visit their PCP for help accessing community services, managing their multiple health conditions and prescriptions, and receiving treatment for the aches and pains common to aging and illness.

Even though pain is one of the more common conditions that clinicians treat among older adults, treatments can be complex. 31 percent of older adults aged 65 or over report experiencing chronic pain. While managing pain for their patients, in the face of the opioid epidemic, physicians should ensure that their patients aren’t struggling with or developing substance use disorders by:

• screening for substance use disorders
• monitoring patients for opioid use complications
• offering opioid alternatives
• prescribing and monitoring the impact of medication-assisted treatment (MAT)

With PCPs prescribing nearly half of the opioid prescriptions in the United States and over a million older Americans living with substance use disorder, it is imperative to ensure that PCPs have the education and tools to work with their patients and address these four areas. 

Approach

To address these challenges, Altarum has partnered with the University of Michigan in the Reframing Optimal Management of Pain and Opioids in Older Adults (ROMPO) program. The program is funded by a grant from the Agency for Healthcare Research and Quality (AHRQ) and provides primary care practices with comprehensive education and tools to respond to the unique challenges they face when caring for older patients seeking pain treatment. Altarum oversees the administration, provides customization for each site, and assesses the long-term impact of the program.

PCPs and their teams are well-positioned to provide safe, comprehensive pain management strategies to older adults. The ROMPO program helps PCPs by teaching them how to measure and document a patient’s pain using the Pain, Enjoyment of Life, and General Activity (PEG) scale as part of a comprehensive approach to improving functionality and well-being. It also incorporates an ambulatory pain order set into patients’ charts for easy access to medication and referral orders, as well as clinical decision support. In addition, the program teaches shared decision-making strategies to help empower older adults to become active participants in their medical care, offers prescriber support and clinician resources, and provides a dedicated Altarum practice facilitator who customizes technical assistance for each participating clinic. 

One key to success is the practice facilitation approach which improves processes and outcomes through an ongoing, trusting relationship between Altarum’s specially trained practice facilitators and the primary care practices. These facilitators bring deep familiarity with challenges facing older adults, electronic health record customizations, and clinical workflow redesign. They customize the support based on the needs of the practice and provider, and carefully balance the quality improvement goals with those of the clinic, while encouraging the work to improve performance measures.

All these efforts work to improve outcomes for older adult patients experiencing pain.