Identifying Health Outcomes for Integrative Group Medical Visits for Patients With Chronic Pain: Results of Qualitative Interviews With Staff, Administrators, and Providers Working in Safety-Net Settings.

Abstract

While biopsychosocial interventions are recommended for treatment of patients with chronic pain, outcome measurement frequently does not take a multifaceted approach to assessing patient outcomes. As primary care settings increasingly implement chronic pain approaches such as Integrative Group Medical Visits (IGMV), a comprehensive yet pragmatic measurement approach is needed to capture biopsychosocial outcomes. We recruited 21 clinicians, administrators, and staff with direct experience implementing IGMV in safety-net settings to participate in semi-structured qualitative interviews. Participants were recruited from 6 Federally-Qualified Health Centers and 4 Safety-Net Hospital outpatient clinics representing 6 states across the U.S. We first analyzed interview transcripts using the Consolidated Framework of Implementation Research, then used inductive thematic content analysis to identify themes related to what participants currently measure and the outcomes they view as important to be measuring. Thematic content analysis revealed 3 themes: variability of measures chosen, rationale for measures chosen, and desire for biopsychosocial outcome measurement tailored to IGMV for chronic pain. Thirteen different measures were used across 9 sites. The choice of measures was driven by clinical utility and/or administrative incentives. Interviewees described that as patients progressed through IGMV they demonstrated improved health through improvements in social support, self-efficacy in pain management, self-management behaviors, and improved physical function. The measures currently used address most but not all these outcomes. We recommend developing and refining a biopsychosocial outcome measurement tool that addresses unique aspects of IGMV. These findings contribute to a growing consensus on how to measure actionable, patient-centered data on biopsychosocial interventions for chronic pain.