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Guidelines for Transitioning Diabetic Patients to Adulthood

Guidelines for Transitioning Diabetic Patients to Adulthood

The American Diabetes Association (ADA) published a position statement in the November issue of Diabetes Care outlining strategies to effectively transition patients with diabetes from pediatric to adult providers. Between 18 and 30 years is the transitional period when it’s critical to ensure the continuity of care for patients, especially given the many changes in lifestyles young adults go through as they go to college or begin to support themselves. Despite existing guidelines, physicians are often confronted many obstacles in the management of diabetes around this age. Some of the ADA Recommendations for Youth-Adult Care Transition include: At least 1 year before the transfer to adult healthcare providers, pediatric providers should collaborate with the patient and family to prepare for the upcoming transition in healthcare delivery. The pediatric provider should provide the patient and adult provider with a written summary including an active problem list, medication list, diabetes self-care skills evaluation, summary of past glycemic control and diabetes-related comorbidities, summary of any mental health problems, and referrals during pediatric care. Pediatric and adult care providers both should offer support and referrals to resources that may assist the patient in case there is a loss of consistent healthcare or in case they become lost to follow-up. To prevent acute and long-term complications of diabetes, adherence to and consistent use of glucose-lowering medications must be emphasized. Emerging adults with diabetes should be assessed and treated for disordered eating behaviors and affective disorders, with referral as needed to a mental health provider familiar with diabetes care. Pediatric and adult clinicians should discuss with emerging adults how diabetes may affect birth control, pregnancy planning...
Special eNewsletter for National Diabetes Month

Special eNewsletter for National Diabetes Month

November is National Diabetes Awareness Month, and Physician’s Weekly has teamed up with the American Diabetes Association to bring healthcare professionals expert-interviewed features on strategies to best manage diabetes. Sign up for our Physician’s Weekly newsletter to receive an additional weekly eNewsletter dedicated to hot topics in diabetes care for the month of...
Need a Blood Glucose Meter? There’s an App for That!

Need a Blood Glucose Meter? There’s an App for That!

A new device allows patients with diabetes to monitor their blood glucose using a smartphone.  Smartphone applications that assist people with myriad aspects of their lives seem to be emerging hourly, so it was only a matter of time before they permeated healthcare. iBGStar® is a new blood glucose meter for iPhones or iPod touch that fits seamlessly into busy lifestyles. Patients first diagnosed with diabetes typically have to check their blood often, and those with long-established diabetes may have to check multiple times a day, depending on many factors such as the number of insulin doses they’re prescribed. Blood glucose meters can help guide patients when selecting foods, portions, exercise, and medication doses. The innovative  iBGStar® attachment connects to the iPhone and iPod touch, allowing patients to view and analyze accurate, reliable information. The application accompanying the device will keep track of blood glucose, carbs intake, and insulin dose, as well as enabling patients to input data and specific notes for personalized information. This may help physicians analyze patterns and variations to make better-informed diabetes management decisions. Physician’s Weekly wants to know… Would a device like this help you better manage patients with diabetes?     | More...

Quality Measures for Parkinson’s Disease Care

Quality measures have been developed for many different frameworks of medical care to address structures, processes, and/or outcomes. They also address important components of healthcare quality, including patient safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. Performance metrics and quality measures are increasingly becoming important for measuring progress and determining reimbursement for physicians and other providers. “When these measures are utilized in their entirety, they provide a framework for uniform quality and assessment of the many facetsand presentations of PD.” The American Academy of Neurology (AAN) established its own measures to improve the quality of treatment provided for Parkinson’s disease (PD) and to better understand how to improve quality of life in this patient group. In the November 30, 2010 issue of Neurology, my colleagues and I published a set of 10 quality measures for the care of patients with PD that were endorsed by the AAN. These measures are the result of a collaboration of a 28-person expert panel. Each measure identifies the patient population eligible for the measure—all patients with a diagnosis of PD—and identifies the temporal application. Once clinicians determine whether patients are eligible, then the measure states how it’s fulfilled. Clinicians managing patients with PD can then implement strategies to identify appropriate candidates and determine how to conduct assessments. Summarizing Quality Measures for Parkinson’s Disease Six of the measures address the assessment of PD symptoms, three cover the current diagnosis and treatment, and one covers patient safety and counseling on preventable complications. The first quality measure for PD is that all patients with the disease have their diagnosis and current medications reviewed at least annually, including a review...

The Changing Tide of Knee Arthroscopy in the U.S.

CDC data show that knee arthroscopy is one of the most frequently performed ambulatory orthopedic procedures in the United States. The surgery is now primarily used for the removal of loose bodies, debridement of meniscal tears, debridement and recontouring of cartilage flaps, arthroscopically assisted ligament reconstruction and meniscal transplantation, and synovectomy. In the early 1980s, there was a shift toward performing some surgical procedures on an outpatient basis for a variety of reasons. “Advances in anesthesia and surgical techniques, financial incentives to providers and patients, and enhancements in postoperative pain management were all factors that led to this shift,” explains Richard A. Marder, MD. “It’s well understood that the number of ambulatory surgical procedures is increasing, but there has been little study exploring the frequency and magnitude of these procedures occurring in outpatient settings in the U.S.” Significant 10-Year Trends In the June 1, 2011 Journal of Bone and Joint Surgery, Sunny H. Kim, PhD, Jose Bosque, MD, John P. Meehan, MD, Amir Jamali, MD, and Dr. Marder had a study published that described the changes in demographics and utilization of knee arthroscopy in ambulatory settings between 1996 and 2006 in the U.S. The investigation, which analyzed CDC data from the National Survey of Ambulatory Surgery, also sought out to determine the most common reasons for knee arthroscopy over the past decade. “Our analysis revealed several interesting trends,” says Dr. Marder. “First, between 1996 and 2006, the number of knee arthroscopies increased by 49% (Table 1). The increase in knee arthroscopy procedures was much steeper than the growth of the U.S. population during the same period.” “Clinicians should continue to...

A Quality Improvement Strategy to Reduce Infection Rates

An estimated 80,000 patients each year experience catheter-related bloodstream infections during treatment in hospitals, about 31,000 of whom die, and the cost of treating these infections may be as high as $3 billion nationally. In 2009, the United States Department of Health and Human Services called for a 50% reduction in catheter-related infections nationwide by 2012. Institutions throughout the U.S. have initiated different interventions to accomplish this feat, but with varying degrees of success. Reducing Bloodstream Infection Rates Several years ago, the Keystone ICU Project was launched. Developed by Johns Hopkins University in partnership with the Michigan Hospital Association, the project utilizes a checklist for healthcare providers to follow when placing catheters. The checklist highlights five basic steps to decrease catheter-related bloodstream infection rates: 1. Promoting hand washing. 2. Full barrier precautions. 3. Skin antisepsis with chlorhexidine. 4. Avoiding the femoral site during catheter insertion. 5. Removing unnecessary catheters. Along with the checklist, the Keystone ICU Project promotes a culture of safety consisting of safety science education, training in the identification of potential safety problems, development of evidence-based solutions, and measurement of improvements. A key aspect of the program was to empower all caregivers—regardless of their level of experience—to question each other and stop procedures if safety is compromised. Profound New Data on Eliminating Infections In the January 31, 2011 issue of BMJ, my colleagues and I had a study published. It found that the virtual elimination of catheter-related bloodstream infections in ICUs throughout Michigan through the Keystone Project correlated with a 10% reduction in mortality rates in the state when compared to surrounding states. Using Medicare claims data, we...

Recommendations Released for Familial Hypercholesterolemia

Familial hypercholesterolemia (FH), a group of genetic defects that cause elevations in cholesterol levels, is associated with preventable, premature cardiovascular disease (CVD), and can be broken down into heterozygous and homozygous forms (Table 1). Early and accurate diagnosis and treatment are crucial in avoiding cardiovascular events and death. “FH is very treatable,” says Anne C. Goldberg, MD, FNLA, FACP, FAHA, “and is one of the more common genetic disorders in which treatment can decrease the risk of early cardiovascular disease.” The National Lipid Association (NLA) released clinical practice recommendations on the screening, diagnosis, and management of patients with FH, focusing heavily on early recognition and treatment. The recommendations were published in the June 2011 Journal of Clinical Lipidology. “Most clinical guidelines for cholesterol treatment have discussed the importance of cholesterol levels and cholesterol as a risk factor for CVD but don’t really address FH in any great detail,” explains Dr. Goldberg, who was the chair of the writing group that developed the recommendations. “As such, the NLA recommendations may contribute by helping physicians to recognize FH in particular and then manage these patients appropriately based on the available scientific evidence.” Be Suspicious of FH Among Children Among the key recommendations made by the NLA is for universal cholesterol screening for elevated serum cholesterol. All children aged 9 to 11 should be screened. Healthcare providers should suspect FH among children and adolescents under the age of 20 with LDL cholesterol of 160 mg/dL or higher or non-HDL cholesterol of 190 mg/dL or higher and in anyone aged 20 or older who has LDL cholesterol levels of 190 mg/ dL or higher...
65% of Patients with MS Have Trouble Walking

65% of Patients with MS Have Trouble Walking

Approximately two-thirds of people with MS report an inability to walk or have difficulty maintaining balance at least twice per week, yet 40% of these patients “rarely or never” mention the problems to their physician, according to a Harris Interactive online survey. The landmark survey — conducted on behalf of the National Multiple Sclerosis Society (NMSS) and presented this week — revealed that younger people with MS are less likely to initiate a conversation with their doctor about walking difficulties, and only 46% of patients aged 41 or younger who do discuss the topic initiate the conversation. The study comprised more than 1,200 adults in the United States over age 18. Additional findings for adults who experienced difficulty walking were: 79% who are employed report it has negatively impacted them at work. 60% have had to miss at least one major personal event as a result. 32% report that it has caused them to feel isolated. “Clearly we need to encourage and empower people with MS to discuss walking impairment with their doctor,” said Nicholas LaRocca, PhD, Vice President for Health Care Delivery and Policy Research at NMSS, “including newly diagnosed patients who may be experiencing only mild problems with walking ability or balance, so that these issues can be addressed.” Physician’s Weekly wants to know… How can physicians encourage and empower patients to discuss issues with their...
Why Are Your Patients Hiding Their Depression?

Why Are Your Patients Hiding Their Depression?

Most patients who don’t disclose their feelings of depression to their primary care providers (PCPs) are primarily afraid they will be prescribed antidepressant medication, according to survey results published this month in the Annals of Family Medicine. Depression goes undiagnosed in one-fourth of primary care patients with major depressive disorder, or MDD, and the majority of those who seek help from a PCP do not receive appropriate treatment. In a follow-up telephone survey of more than 1,000 adults, researchers from the University of California asked patients why they would not discuss depressive symptoms with their PCP. Overall, the following reasons were given: 23% had an aversion to antidepressant medication. 16% felt that a PCP was an inappropriate source of care for emotional problems. 15% were afraid medical records would be seen by others, such as an employer. 13% didn’t want to be sent to a counselor or psychiatrist. 12% didn’t want to be considered a psychiatric patient. 9% were uncomfortable sharing private information with their doctor. 8% felt they might lose emotional control. 6% were uncertain about how to raise the topic. 5% concerned they would distract doctor from other health problems. 4% thought the doctor might think less of them; loss of esteem. According to the findings, patients who exhibited moderate or severe depressive symptoms were more likely to subscribe to those reasons. Medication aversion (28%), sharing of medical records (26%), losing emotional control (21%), and being referred to as a psychiatric patient (20%) were the highest among those patients. The investigators noted that depressed individuals may perceive their circumstances and competencies in a more negative light. Additionally,...

Conference Highlights: 2011 Interscience Conference on Antimicrobial Agents and Chemotherapy

New research presented at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy, or ICAAC, from September 17-20, 2011 in Chicago addressed important issues on antimicrobial therapies and infectious diseases. The features below highlight just some of the studies that emerged from the meeting. » Bloodstream Infections & Colorectal Cancer Screening » S. Aureus Implicated in Many Skin Infections » Rapid Clostridium difficile Diagnosis Improves Patient Care » Antibiotic Prescription Trends » Maggots Heal Difficult Wounds in Diabetics » Hospital Privacy Curtains Frequently Contaminated  Bloodstream Infections & Colorectal Cancer Screening The Particulars: Previous research has established a link between colorectal cancer and bloodstream infections with certain bacteria. Data Breakdown: In a study of 1.2 million people, researchers detected 10,121 bloodstream infections and made 3,859 colorectal cancer diagnoses, and 71 colorectal cancer diagnoses were made during the year following infection. The risk of a colorectal cancer diagnosis in the year following bacterial bloodstream infections was 14 times that of the “normal” population. Anaerobic bacteria of the gut were associated with a 115 times greater risk of a colorectal cancer diagnosis. Take Home Pearl: Patients with bloodstream infections should be targeted for colorectal cancer screening due to their increased risk for the disease within 1 year. S. Aureus Implicated in Many Skin Infections [back to top] The Particulars: Much is known about the causative pathogens in skin and skin-structure infections, but little is known specifically about acute bacterial skin and skin-structure infections (ABSSSI). Data Breakdown: An analysis of a large, multihospital database found that the most common cause of ABSSSIs among patients hospitalized in the United States appeared to be Staphylococcus aureus. Approximately 60% of patients with ABSSSI had S. aureus infections, almost...
Top 10 States Having Hospitals With Palliative Care

Top 10 States Having Hospitals With Palliative Care

On average, our nation gets a “B” for hospital support care, according to a new report released by the Center to Advance Palliative Care. The report surveyed nearly 2,500 U.S. hospitals and graded states on how many of their hospitals provide palliative care—support and coordination of medical service for chronically ill patients and their families. Counting only hospitals with 50 or more beds, R. Sean Morrison, MD, and Diane E. Meier, MD, graded states on the percentage of hospitals that have palliative care teams. States got an “A” for having palliative care teams in 83% or more of their hospitals; a “B” for 61% to 80% of hospitals; a “C” for 42% to 60% of hospitals; a “D” for 28% to 38% of hospitals; and an “F” for 0% to 20% of hospitals. Overall, the report found that 85% of hospitals with more than 300 beds and 63% of hospitals with more than 50 beds have a palliative care team. That gives the nation an overall “B” grade. Among the findings of which states had hospitals that offered the most palliative care: Top 10 States: District of Columbia — 100% of hospitals have palliative care teams Vermont — 100% Nebraska — 93% Maryland — 90% Minnesota — 89% Oregon — 88% Rhode Island — 88% Washington — 83% New Jersey — 80% Ohio — 80% Bottom 10 States: New Mexico — 44% Louisiana — 43% Georgia — 43% Texas — 42% Arkansas — 38% Oklahoma — 30% Alaska — 29% Alabama — 28% Delaware — 20% Mississippi —...
Statins Improve Brain Injury Survival Rates by 76%

Statins Improve Brain Injury Survival Rates by 76%

Patients taking cholesterol-lowering statins when admitted to the hospital for a brain injury are 76% more likely to survive than those who are not taking the drugs, according to a recent Johns Hopkins study published in this month’s issue of The Journal of Trauma.  These patients also had a 13% greater chance of attaining high-quality recovery after 1 year. While there are currently no specific treatments for traumatic brain injury, these latest findings may direct researchers toward one. Although lower cholesterol is not likely the reason for the improved recovery rate, researchers believe that other, lesser-known properties of statins could be responsible. Eric B. Schneider, PhD, and his team at Johns Hopkins analyzed more than 520 patients over 65 who experienced moderate to severe brain damage. Those taking statins were 76% less likely to die; however, those who also had documented heart disease did not experience the same benefits. Previous studies have linked the anti-inflammatory effect of statins to better survival after stroke and other types of trauma. Researchers surmise that statins may curb the body’s immune response, preventing the attack of healthy brain tissue and limiting it to damaged tissue. Additionally, statins may prevent more extensive damage by blocking chemical byproducts and excess white blood cells from crossing the blood-brain barrier. The next step is a clinical trial to see if statins administered in the emergency room to brain-injured patients who were not taking statins at the time of their injury could help them...

Comparing Hysterectomies for Endometrial Cancer

Each year, more than 40,000 women are diagnosed with endometrial cancer in the United States. This diagnosis, often resulting in the need for a hysterectomy, leads many patients to consider their treatment options. Tradi­tionally, the surgical options have been somewhat limited for these women, including open hysterectomy and laparos­copy. Open hysterectomy has been associated with important caveats for patients to consider, including scarring, excessive procedural blood loss, and extended hospital stays with long recovery times. Minimally invasive laparoscopy significantly reduces some of the risks associated with open hysterectomy. Robotic surgery equipment has also emerged after receiving FDA clearance in 2005, and these procedures are increas­ingly being used for patients with endometrial cancer. Treatment Options for Endometrial Cancer In the December 2010 issue of Obstetrics & Gynecology, my colleagues and I reviewed eight studies involving nearly 1,600 women who underwent open surgery, laparoscopy, robot-assisted hysterectomy, or lymph node dissection. We compared them with laparoscopic or laparotomy cases to analyze surgical technique, complications, and periopera­tive outcomes. Comparative studies that looked at clinical outcomes of robotic-assisted surgeries were also summarized and compared with traditional laparoscopic or laparotomy techniques for the treatment of endometrial cancer. “Robotic-assisted surgery has the potential for enhancing outcomes in women receiving operative treatment for endometrial cancer.” According to our analysis, women undergoing surgery for endometrial cancer can benefit from minimally invasive hysterectomy that is performed by skilled surgeons with or without the help of robotic technology. Laparoscopic surgery with or without robotic assistance took about the same time to complete and resulted in similar hospital stay durations. It should be noted, however, that about half as much blood was...

Screening Recommendations for Osteoporosis

Over half of all postmenopausal women will develop a fracture related to osteoporosis during their lifetime, including 15% who will suffer hip fractures. Although fewer men than women develop osteoporosis, more than one-third of men who sustain a hip fracture die within 1 year. A new statement issued by the United States Preventive Services Task Force (USPSTF) aims to provide clinicians with current, evidence-based recommendations for osteoporosis screening. These recommendations, published in the January 2011Annals of Internal Medicine, are designed to assist clinicians on the appropriate time to initiate osteoporosis screening based on patient characteristics and clinical data. Major Modifications to Osteoporosis Recommendations In 2002, the USPSTF recommended to routinely screen women aged 65 and older for osteoporosis and screen women between the ages of 60 and 64 with an increased risk for osteoporotic fractures. Since 2002, a wealth of data has emerged on risk among younger women. Accordingly, the new recommendation extended screening for osteoporosis to women aged 65 or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old Caucasian woman who has no additional risk factors. The current guidelines contain no recommendation for or against osteoporosis screening in younger women. “Validation studies on tools to predict osteoporosis risk have been completed, and these investigations have revealed that risk assessment tools can accurately identify potential osteoporosis risk.” In 2002, a single osteoporosis screening tool was not recommended for universal use. Since that time, validation studies on tools to predict osteoporosis risk have been completed, and these investigations have revealed that risk assessment tools can accurately identify potential osteoporosis risk. The World...

An Effective Intervention for Chronic Insomnia in Older Adults

Insomnia is a sleep disorder characterized by difficulty falling and/or staying asleep,together with daytime symptoms, such as fatigue, irritability, and poor concentration. The condition is highly prevalent among older adults, with almost a third reporting some symptoms of insomnia. While symptom severity may vary, 10% of older adults suffering from insomnia experience persistent and significant health and functional consequences that approach and sometimes exceed quality of life problems that are seen with other chronic conditions, such as congestive heart failure and depression. Several treatments for insomnia are available, but a common barrier to diagnosis and treatment in the elderly is physician reluctance to assess this patient group for insomnia. “Pharmacotherapy, a standard treatment for insomnia, is effective but has been associated with significant side effects and safety concerns,” explains Daniel J. Buysse, MD. “Insomnia itself may lead to fatigue, cognitive impairment, and increased risk for falls and hip fractures in older adults. Hypnotic medications may further increase those risks.” Cognitive behavioral therapy for insomnia (CBTI) is another effective strategy for treating older adults. It is often preferred by patients and has few apparent adverse effects, but CBTI typically involves several treatment sessions with clinical psychologists. This approach is often not readily available to older adults, especially to those with fixed incomes. Assessing a New Insomnia Intervention In the May 23, 2011 Archives of Internal Medicine, Dr. Buysse and colleagues published a study that examined the efficacy and feasibility of a potential new treatment option for physicians caring for older patients with insomnia. The study sought to evaluate the short-term efficacy and 6-month durability of a brief behavioral treatment for insomnia (BBTI)...
MedPAC Supports SGR Pay Formula Repeal

MedPAC Supports SGR Pay Formula Repeal

The Medicare Payment Advisory Commission (MedPAC) has officially endorsed the repeal of the sustainable growth rate (SGR) formula, which determines physician payments from Medicare, in hopes of replacing it with a 10-year fixed rate for primary care physicians and cuts in payments to specialists. The proposal was originally presented by the MedPAC staff at the commission’s meeting in September. Payments to primary care physicians would freeze for 10 years; specialist payments would be reduced by 5.9% per year for 3 years and then frozen. The SGR formula connects physician reimbursement rates to increases in the gross domestic product (GDP). Since spending on physician services has outpaced increases in the GDP, the SGR formula required cuts to be made in reimbursements each year over the past decade.  However, Congress has always postponed those cuts. Come January 1, an SGR-triggered pay cut of 30% in physician reimbursement is scheduled—a price too high to sustain physician participation in Medicare, particularly primary care providers. As a result, cuts were recommended only for specialty providers, while freezing reimbursement rates for primary care physicians. The endorsed plan to repeal the SGR formula will cost around $200 billion; MedPAC has developed strategies to pay for it. The proposal will reach Congress later in October. If Congress doesn’t act on the plan or develop an alternative before the first of the year, a 30% cut in Medicare payments mandated by the SGR will be implemented across the board for all providers. Physician’s Weekly wants to know… Do you think the repeal fixes the crisis — or only creates a new one? Will this have an effect on...
Legislating Semantics: Should a Nurse Be Called ‘Doctor’?

Legislating Semantics: Should a Nurse Be Called ‘Doctor’?

Nurses introducing themselves as “doctor” may not be too common today, but by 2015 doctorates may be required of all nurse practitioners. The question is, will these highly educated nurses be able to use the title of “doctor” in a professional setting? If some physician opponents have their way, that distinction will remain with them. In the context of healthcare, most patients perceive a “Dr.” to be a physician. There is concern that patients will be confused if other professionals they encounter in medical settings refer to themselves as doctors. And patients may see RNs holding doctorates as better or more qualified clinicians than other nurses; however, at present no practical or clinical differences exist between nurses who earn master’s degrees and those who attain doctorates. According to news reports, physicians and their allies are pushing for legislation to restrict the use of the title of “doctor.” For example, a bill introduced in the New York State Senate would bar nurses from advertising themselves as doctors, no matter their degree. A law proposed in Congress would bar people from misrepresenting their education or license to practice. However, those who support the free use of the title say that the term “doctor” refers to one who earns the highest academic degree in their field and that medicine “permanently borrowed” this title from academia. After all, the reasoning goes, if you’ve worked hard to earn the rights and privileges associated with a degree, you shouldn’t be denied the official...

Updated Guidelines for Managing Atrial Fibrillation

Atrial fibrillation (AF), the most common cardiac arrhythmia, affects 2.2 million Americans and is reaching epidemic proportions since its prevalence grows as the older population continues to increase. AF is a major risk factor for stroke if it is not appropriately diagnosed and managed. Updated guidelines on the management of patients with AF were jointly released by the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society in the December 2010 Journal of the American College of Cardiology. “The guidelines reflect a consensus of expert opinion and a thorough review of clinical research,” explains L. Samuel Wann, MD, MACC, FAHA, who chaired the expert group writing committee. “The new recommendations update guidelines that were previously released in 2006. They are based on evidence from clinical trials, as well as expert opinion. The update was precipitated by several new areas of research that have recently become available.” Major Modifications to Atrial Fibrillation Recommendations Several major modifications were offered in the updated guidelines for AF, one of which focuses on heart rate control (Table 1). The RACE II study was one of the primary reasons for revising the guidelines on heart rate control. It found that a strict heart rate control regimen with exercise testing provided no benefit over a more lenient heart rate control regimen. “This is an important modification because it means that physicians won’t need such rigid heart rate reevaluations, which often require exercise tests and the use of multiple drugs,” says Dr. Wann. “Symptomatic patients, however, do require treatment, and the long-term adverse effects of persistent tachycardia on ventricular function are still of concern.”...

Pain Management: A Look at Provider Perspectives

It has been well established that pain is the most commonly reported symptom in primary care and a leading cause of disability. Primary care providers (PCPs) face numerous challenges in caring for patients with chronic pain. Pain is subjective, and there are no objective tests that confirm the level of pain people experience. One patient might rate pain as a 4 on a 1-to-10 pain scale while another might label the same degree of pain as a 6 or 7. The successful treatment of chronic pain is challenging, especially in cases for which no sure cause of the pain can be identified. Alleviating pain can be elusive, which becomes frustrating to both patients and PCPs. It can also put a strain on the patient-provider relationship, which can ultimately impact the well-being of both parties. Elucidating the Provider’s Perspective Many studies have looked at the treatment of chronic pain from the patient’s perspective, but there has been little research on those who provide care for these patients. In a study published in the November 2010 issue of Pain Medicine, my colleagues and I surveyed 20 PCPs with open-ended questions to elicit their perspectives on experiences in caring for patients with chronic pain. A central theme from our investigation was that chronic pain takes a real toll on PCPs and their patients. Three other broad themes also emerged from our analysis. First, providers emphasized the importance of the patient-provider relationship, asserting that productive relationships with patients are essential for good pain care. Second, providers detailed the difficulties they encountered when caring for patients with chronic pain. These included: – Feeling pressured to...
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