Background & Aims
Nearly 70% of emergency department (ED) visits are due to pain. Chronic pain prevalence is often higher in those living in poverty and on public assistance. Such populations are more likely to receive healthcare in the ED. Evidence based-guidelines recommend multimodal approaches to manage pain and minimize opioids. Utilizing nonpharmacologic integrative options and teaching healthy pain management strategies provides a comprehensive approach for managing pain in acute or chronic conditions. Programs promoting multimodal approaches exist, but there is minimal data on program outcomes in vulnerable and underserved populations with limited resources and access to nonpharmacologic modalities. Patients participating in a model pain education program in the ED of a U.S. safety-net hospital system were surveyed one-month following their session to assess continued home use of program education and materials, as well as perceived helpfulness in home pain management.
Methods
A pain education program was implemented in the ED, inpatient, and outpatient settings of a safety-net hospital system from 1/1/2021 – 1/31/2024. During program sessions, participants received tailored education, resources and materials (“pain toolkits”) to assist with home pain management. Program eligibility included patients ? 14 years of age experiencing pain, with cognitive capacity to participate in sessions; suicidal, violent and incarcerated patients were excluded. One-month follow-up phone surveys (11/2021 to 2/2024) were performed to assess home pain toolkit utilization, adherence, and perceived program value. A sub-analysis of surveys completed by ED patients was conducted comparing survey responses by sociodemographics, including area deprivation index (ADI) national percentile, and session characteristics. All analyses were performed using R statistical software. This project was registered with the university’s Quality Improvement Project Registry.
Results
Of the 896 ED patients completing a session, 284 (32%) also completed a follow-up survey. Most surveyed patients were Black (68%), female (74%), living in socioeconomic disadvantage (mean ADI 76) and had acute pain (65%). Mean age and session length were 47.2 years and 16.8 minutes, respectively. Hot/cold therapy (97%) and aromatherapy (95%) were common session topics. Most (85%) rated their session as helpful at session conclusion. At one-month, 90% reported using program materials at home; 77% reported their session as very helpful/helpful; and 83.1% would recommend the program to others. Many reported daily (33%) or weekly (44%) use of toolkit items. Black patients (p<.05) and those reporting sessions as helpful at session end (p<.01) were both more likely to use toolkit items at home. Patients with acute pain (p<.005) and longer sessions (p<.05) were more likely to recommend the program to others one-month after their session. No other comparisons were significant.
Conclusions
Most participants of a new model pain education program implemented within a majority socioeconomically disadvantaged ED patient population, reported home use of program education and materials one-month after their ED session. This was particularly true in Black patients and those who rated the session as helpful at session conclusion. Patients presenting to the ED with acute pain and those who had longer sessions were more likely to recommend the program to others. The pain education program appears to be most beneficial in Black patients and those with acute pain. These findings underscore the importance of providing multimodal approaches to pain management, especially in underserved and international communities. Future studies plan to explore implementation barriers at home.
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Presenting Author
Megan Curtis Gonzalez
Poster Authors
Megan Curtis Gonzalez
PhD
University of Florida College of Medicine - Jacksonville
Lead Author
Sophia Sheikh
MD
University of Florida College of Medicine - Jacksonville
Lead Author
Magda Montague
MPH
University of Florida College of Medicine – Jacksonville
Lead Author
Michelle Lott
BSH
University of Florida College of Medicine – Jacksonville
Lead Author
Nolan Menze
BSH
University of Florida College of Medicine – Jacksonville
Lead Author
Leighton Cleveland
BSH
University of Florida College of Medicine – Jacksonville
Lead Author
Katelyn Perl
MS
University of Florida College of Medicine – Jacksonville
Lead Author
Amy Crisp
PhD
University of Florida College of Medicine – Jacksonville
Lead Author
Robin Moorman Li
PharmD
University of Florida College of Medicine – Jacksonville
Lead Author
Phyllis Hendry
MD
University of Florida College of Medicine – Jacksonville
Lead Author
Topics
- Education