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The efficacy of a brief behavioral health intervention for managing high utilization of ED services by chronic pain patients.

Research paper by Jonathan J Woodhouse, Mary M Peterson, Clark C Campbell, Kathleen K Gathercoal

Indexed on: 15 Sep '10Published on: 15 Sep '10Published in: Journal of Emergency Nursing



Abstract

Patients with chronic pain continue to seek medical care from emergency departments nationwide despite the fact that an emergency department is a less-than-optimal environment for meeting their specific and specialized needs. As the scientific community has gained a more sophisticated understanding of the mechanisms that contribute to the development and maintenance of chronic pain, the central role of psychological factors have emerged. Therefore, an ED-based, behavioral health intervention for chronic pain patients is needed to better serve this population and to help hospitals provide cost effective treatment at the appropriate level of care.The setting was a 40-bed, acute-care hospital with a 15-bed emergency department seeing 16,500 patients annually. All participants were chronic pain patients utilizing the emergency department for pain management. This study was a program evaluation utilizing a quasi-experimental, retrospective, pre-test/post-test, split-plot design.A repeated measures analysis of variance (ANOVA) was used to compare high-utilizers (>4 emergency department visits in 6 months) to low utilizers in total ED visits 6 months before and after the intervention. The low utilizers mean ED visits remained stable before and after the intervention while the high utilizers showed a decrease in ED utilization. This differential response between groups was statistically significant (P < .05).This study suggests that an ED-based behavioral health consultation may be useful for reducing high utilization of ED services by some chronic pain patients, particularly those who consume the most services.