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Interventions to address deficits of pharmacological pain management in nursing home residents – A cluster‐randomized trial
Author(s) -
Könner F.,
Budnick A.,
Kuhnert R.,
Wulff I.,
Kalinowski S.,
Martus P.,
Dräger D.,
Kreutz R.
Publication year - 2015
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.663
Subject(s) - medicine , psychological intervention , intervention (counseling) , randomized controlled trial , physical therapy , cluster (spacecraft) , pain assessment , pain management , nursing , computer science , programming language
Background To evaluate the effect of interventions for general practitioners and nursing home staff to improve pain severity and appropriateness of pain medication in nursing home residents ( NHR ). Methods This cluster‐randomized controlled trial was conducted in six nursing homes in the intervention and control group, respectively. Pain management was analysed before (T0) and after (T1, T2) an educational intervention in 239 NHR , aged ≥65 years, without moderate or severe cognitive impairment. Primary and secondary outcomes were average pain severity and appropriateness of pain medication as determined with the Numeric Rating Scale and Pain Medication Appropriateness Scale ( PMAS D ), respectively. Results At T0, 72.2% and 73.7% of NHR (mean age 83 years) reported pain (average pain severity 2.4) in the intervention and control group, respectively. The PMAS D at T0 was 53.9 in the intervention group and 60.8 in the control group ( p = 0.12), while 20.6% compared to 6.9% ( p = 0.009) received no pain medication in the two groups. At T2, non‐significant improvements in the average pain severity (1.59) and PMAS D (61.07) were observed in the intervention group. Moreover, the mean individual PMAS D increased by 8.09 ( p = 0.03) and the proportion of NHR without pain medication decreased by 50% ( p = 0.03) in the intervention group. No appreciable changes were found in the control group at T2. Conclusions NHR exhibited a high prevalence of pain with overall low severity, while a high proportion of individuals received inappropriate pain medications. Both findings were not significantly improved by the intervention, although some aspects of drug treatment were meaningful improved.