Background & Aims
Patients with limited English proficiency (LEP) often experience challenges with pain management due to cultural and language barriers between them and healthcare providers. Research shows that LEP populations receive suboptimal pain management. The purpose of this study is to assess the impact of a pilot communication intervention, called the pain assessment information visualization (InfoViz) tool on provider’s pain management for LEP Hmong patients. We hypothesized that the pain InfoViz tool would improve 1) discussion of pain medication and 2) patient referrals to receive therapy such as physical and occupational therapy.
Methods
We conducted a retrospective electronic health record (EHR) study of patient visits who participated in a pilot communication intervention study using a static group comparison design, with triads of LEP Hmong patients, interpreters, and healthcare providers in primary care clinics in a Midwestern academic healthcare setting. The abstracted data included: (1) type of pain (i.e., chronic vs acute) and (2) pain management-related outcomes. Descriptive statistics (frequency, counts, percentages) were calculated for each outcome variable. We also calculated the proportional difference effect size for group mean comparisons between the observation and intervention groups, for each outcome variable using Cohen’s h. Using Cohen’s d interpretation guidelines: a small effect is 0.20, a medium effect is .50, and a large effect is .80.
Results
A total of 36 patients were analyzed (n=18 in the observation group, n=18 in the intervention group). The majority of participants were female (80%) with a mean age of 56± 11.98 and had an average length of stay in the US of 25 ± 12.15 years. Overall, there was an improvement in patient referrals to therapies from the observation (33%) to the intervention group (55%) for patients with chronic pain; this has close to a medium positive effect (Cohen’s h = 0.447). Furthermore, there was a small positive effect for discussing the side effects of prescribed medication (h =0.297) and having existing therapies prescribed (Cohen’s h = 0.251) for patients with chronic pain. In contrast, there was a large positive effect size for patients currently taking pain medications (Cohen’s h = 1.165), discussing side effects of prescribed pain medication (Cohen’s h = 0.976), and having existing therapies prescribed (Cohen’s h =0.976) for patients with acute pain.
Conclusions
We found that the pain assessment InfoViz tool has a positive impact on patient referrals to therapies, and various positive effects were observed in discussions and prescriptions related to medication and therapies for pain management, especially among those with chronic pain. A larger research study is needed to confirm the impact of the pain assessment InfoViz tool on pain management outcomes.
References
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