Conjoint Sessions With Clinical Pharmacy and Health Psychology for Chronic Pain

Limitations

Some limitations and suggested future directions found as part of this QI project have been outlined earlier. Other limitations include the used of a retrospective review of information available in patient medical charts. More developed measurement-based care or research could collect self-reports of patient satisfaction with care, functioning, knowledge, readiness for change, and mood in addition to what is noted and documented in clinical observations. Second, the sample was small and did not include any female and few younger veterans, even though these are important subpopulations when examining pain management services. When resources are available for a larger sample size, some exploratory analyses could be conducted for differences in engagement among subgroups. Third, this project may have further confounding variables as this was not an experimental or a controlled study, which could directly compare conjoint sessions with referral-based care and/or those not offered conjoint sessions.

Conclusion

The optimal method of behavioral pain management suggests the need for an interdisciplinary, coordinated team approach, in which the gold standard programs meet requirements set by CARF. However, on a practical level, optimal behavioral pain management may not be feasible at all health care facilities. Furthermore, in an effort to provide best practices to individuals with chronic pain, clinicians must be adaptive and skilled in using effective communication and specialized interventions, such as CBT and MI.

Approaching the more optimal behavioral self-management of chronic pain from a multimodal interdisciplinary perspective and further engaging veterans in this care is paramount. This project is merely one step in this effort that can shed light on the function and logistic outcomes of using a practical, integrated approach to chronic pain. It demonstrates that implementing best practices founded in sound theoretical models despite staffing and resource constraints is possible. Thus, continuing to explore the utility of alternate modalities may offer important applied and translational information to help disseminate and improve chronic pain management services.

Future research could focus on important subpopulations and enhance experimental design with pre- and postmeasures, controlling for possible confounding variables and if possible a controlled design.

Acknowledgments
This quality improvement project was unfunded, and approval was confirmed with the VA Ann Arbor Healthcare System Institutional Review Board and Research & Development committees. The authors also thank Associate Chief of Staff, Ambulatory Care, Clinton Greenstone, MD, and Chief of Primary Care Adam Tremblay, MD, for their leadership and support of these integrative services and quality improvement efforts. The authors especially recognize the veterans for whom they aim to provide the highest quality of services possible.