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The Characteristics and Effectiveness of Interventions for Frequent Emergency Department Utilizing Patients With Chronic Noncancer Pain: A Systematic Review
Author(s) -
Wong Charles K.,
O'Rielly Connor M.,
Teitge Braden D.,
Sutherland Robert L.,
Farquharson Scott,
Ghosh Monty,
Robertson Helen L.,
Lang Eddy
Publication year - 2020
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13934
Subject(s) - medicine , emergency department , psychological intervention , cinahl , medline , systematic review , randomized controlled trial , health care , chronic pain , meta analysis , emergency medicine , intensive care medicine , physical therapy , nursing , political science , law , economics , economic growth
Background Patients with chronic noncancer pain (CNCP) present unique challenges to emergency department (ED) care providers and administrators. Their conditions lead to frequent ED visits for pain relief and symptom management and are often poorly addressed with costly, low‐yield care. A systematic review has not been performed to inform the management of frequent ED utilizing patients with CNCP. Therefore, we synthesized the available evidence on interventional strategies to improve care‐associated outcomes for this patient group. Methods We searched Medline, EMBASE, CINAHL, CENTRAL, SCOPUS, and Web of Science from database inception to June 2018 for eligible interventional studies aimed at reducing frequent ED utilization among adult patients with CNCP. Articles were assessed in duplicate in accordance with methodologic recommendations from the Cochrane Handbook for Systematic Reviews of Interventions. Outcomes of interest were the frequency of subsequent ED visits, type and amount of opioids administered in the ED and prescribed at discharge, and costs. Methodologic quality was assessed using the Cochrane Risk of Bias in Non‐Randomized Studies of Interventions and Risk of Bias tools for nonrandomized and randomized studies, respectively. Results Thirteen studies including 1,679 patients met the inclusion criteria. Identified interventions implemented pain policies ( n = 4), individualized care plans ( n = 5), ED care coordination ( n = 2), chronic pain management pathways ( n = 1), and behavioral health interventions ( n = 1). All of the studies reported a decrease in ED visit frequency following their respective interventions. These reductions were especially pronounced in studies whose interventions were focused around individualized care plans and primary care involvement. Interventions implementing opioid restriction and pain management policies were largely successful in reducing the amounts of opioid medications administered and prescribed in the ED. Conclusions Multifaceted interventions, especially those employing individualized care plans, can successfully reduce subsequent ED visits, ED opioid administration and prescription, and care‐associated costs for frequent ED utilizing patients with CNCP.