Pain Education Across VA Clinics
Multidisciplinary disease management programs increasingly are bringing together health professionals with different skill sets and expertise to improve patient outcomes. Previous literature has warned of major barriers associated with these large interprofessional systems, and at times, they have resulted in poor patient care.1
One solution that has been proposed to improve patient outcomes in patients treated in such multidisciplinary programs is enhancing teamwork among the various health professionals that are part of the team.2 Teamwork among providers is critically important to patient care and program outcomes. Teams can be bounded (clearly defined workgroups)1,2 or unbounded (workgroups with shifting members). Currently, large workgroups of unbounded professionals are brought together to manage complex patient cases.1,2
The goal interdependence theory of teamwork outlines types of interdependence in teams: negative, neutral, and positive (Figure 1). In positive interdependence, teamwork is considered an important factor for performance when tasks are highly interdependent.1 Teamwork most often is defined as behavioral processes (such as communication) that people use to accomplish interdependent work.2 According to past literature, these behavioral processes can benefit from assessment at the individual and system levels.3 Literature in the area of provider satisfaction tends to examine workload, job satisfaction, and managed care rather than on provider use of disease management programs or provider and patient levels of satisfaction with such programs.4 To address this gap in the literature, the primary objective of the present study was to define and describe provider satisfaction with a health education program.5,6
A group of investigators at the Jesse Brown Veterans Affairs (VA) Medical Center developed working relationships with representatives from more than 20 disciplines, which resulted in a network of facilitators who teach classes in a “Pain Education School” program.5 Pain Education School is an empirically validated, health education program developed at the Jesse Brown VA Medical Center in November 2009, which caters to veterans who suffer from chronic, non-cancer pain. The goals of the program are to share basic principles of pain relief, provide education about pharmacology, introduce services offering non-pharmacological interventions, and promote self-management strategies.7 For the study, 26 providers at the medical center were polled between November 6, 2009 and January 20, 2012 about the program. Approximately 88% of the providers (n=23) completed a voluntary, anonymous satisfaction survey and their responses were analyzed (Table 1). The study protocol was reviewed and approved by the affiliated university’s institutional review board and the VA’s Research & Development office.
Pain Education School consists of 12-weeks of 1-hour classes with an additional 1-hour introduction class during the first week (total of 13 hours). Classes are scheduled on a rotating basis, regardless of the patient’s entry point—the providers in the study rotate on a schedule, not the patients. Over the course of the program, 23 modules are presented (averaging 30 minutes each). A list of the 23 modules is included (see article). There were approximately 4 (12-week) rotations during the year of this study. The class was recommended to 1,138 patients during the year, but it was not a prerequisite for treatment. In fact, it is not recommended that patients be required to go to such classes because that could negatively affect their perspective of the material being learned. Approximately 558 patients (49%) participated in some of these classes during the year. Patients were participating in other pain treatments during the time of the education course. Instructors volunteered their time and received “encounter” credit for the classes they teach.
The Provider Satisfaction and Program Evaluation is a satisfaction measure adapted from an internal VA shared document that was completed by participating providers. Eight items assessed the providers’ perception of the impact of the program on services provided to patients (1=“strongly disagree” to 5=“strongly agree”). Three items assessed the level of use of the program by the providers (1=“never”; 2=“occasionally”; 3=“frequently”). One item assessed the provider’s perception of patient levels of satisfaction (1=“no comment” to 4=”very satisfied”). Providers were then asked an open-ended question that solicited comments and suggestions to improve the program.
Analyses of Data
Morgan’s Priority Sequence Model (1998) is a decision-making process for determining the most applicable research design for complementary combinations of quantitative and qualitative data.8 A quantitative analysis of the data was computed using the IBM SPSS Statistics program. Due to small sample size (n<30), providers’ ratings were assessed using a one-sample t-test to determine confidence intervals (CIs). A qualitative analysis of the data obtained in the surveys was used as a follow-up complementary method and provided interpretative insights.8 Braun and Clarke’s thematic analysis (2006), specifically the inductive semantic approach, supports our aim to organize the data, show patterns, and summarize and interpret the data. Additionally, the thematic analysis approach clearly outlines a sequential guiding process, is compatible with different paradigms, and gives evidence to unrecognized and underlying data.9,10
The majority of the providers were female (58%) and identified as being Caucasian (65%). Providers found the goals and services of the program to be “clear” (mean [M], 4.48; standard deviation [SD], 0.73), perceived that the strategies used “influenced” their practice (M, 4.22; SD, 0.95), perceived that the methods of communication with the coordinators were “helpful” (M, 4.43; SD, 0.79), and perceived the program as having a “positive” impact on their service (M, 4.48; SD, 0.68) with 95% t-distribution CIs of 4.18-4.78, 3.83-4.61, 4.11-4.75, and 4.20-4.76, respectively. Additionally, providers treating patients who underwent the educational program received fewer complaints about pain medications (M, 3.77; SD, 0.92), had fewer walk-ins for pain management issues (M, 3.36; SD, 0.90), spent more time with their patients on other medical problems (M, 3.95; SD, 0.79), and felt more comfortable in managing chronic pain due to the program (M, 4.05; SD, 0.95) with 95% t-distribution CIs of 3.39-4.15, 2.99-3.73, 3.63-4.27, and 3.66-4.44, respectively (5-point Likert scale).