Background: Chronic pain affects millions of people worldwide and the evidence demonstrates prevalent co morbidity of chronic pain and psychological issues such as anxiety, insomnia, and depression. The existence of psychological issues can have negative impact on pain management and compound the challenges inherent to successful management. Although clinical Practice Guidelines (CPG) recommend routine screening for depression, anxiety, and insomnia in all chronic pain patients, many primary care providers fail to routinely perform appropriate screening. The purpose of this project was to implement a practice change that would include screening for depression with chronic pain patients in a rural primary care practice that included seven primary care providers.
Methods: The practice change included development and implementation of a screening tool for psychological issues associated with chronic pain. The tool was designed as a technology prompt only found in pain templates within the electronic health record (EHR). The prompt window opens with a pain complaint, asking whether the patient has depression, sleep problems, or anxiety relating to pain. Prior to implementation of the screening prompt providers were introduced to the EHR modification with one to one educational briefing.
Results: After eight weeks of use, one hundred chronic pain charts were reviewed to determine if the prompt was used and if psychological issues were identified, was appropriate treatment initiated. All seven providers used the prompt with varying degrees of frequency. The prompt was overridden six times. Thirty-one associated problems were discovered. Only two providers treated associated psychological problems when discovered. Depression was discovered four times and treated only once; sleep problems were found in twenty-one patients but only treated six times; and anxiety was positive in six patients but only two were treated.
Conclusions: Initiation of a depression screening tool in the EHR increased the number of patient\u27s psychological assessments during chronic pain evaluation compared to the baseline of zero. Depression screening and initiation of treatment did occur but not at a statistically significant rate. Sleep problems were discovered more than other pain related problems. However, once discovered, it appears that treatments associated problems were not being initiated by the providers. This project demonstrates that an EHR technology prompt can screen for problems associated with chronic pain but does not imply that providers are extensively treating the potentially related conditions when discovered
