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Lisa Charbonneau, DO, MS Medical Director, New England Rehabilitation Hospital of Portland November 2014
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In this session, we will explore current state of knowledge on patient preferences and views on low back pain.
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The utility of patient satisfaction questionnaires – WHY? ▪ Identify ways to improve your practice ▪ Improve care delivery ▪ Results in more satisfied, happier patients ▪ Show staff that you are interested in quality ▪ Marketplace now demands data on patient satisfaction ▪ Provides quality data ▪ Enables practice comparisons standardized assessments on a broad scale
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We have entered the era of pay for performance measures Patient satisfaction scores will figure into the equation for reimbursement for hospitals and physicians
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▪ What do patients want? ▪ Clear diagnosis ▪ Information and instructions ▪ Pain relief ▪ A physical exam (touch the patient!)
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▪ More diagnostic tests ▪ Other therapeutic modalities ▪ Referral to specialists ▪ Certification of disability ▪ Expert confirmation that “their pain is real”
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▪ Understanding ▪ Listening ▪ Respect ▪ Inclusion in decision making
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Reviewing the spectrum of potential outcomes from increased function, elimination of pain to treatment of chronic low back pain ▪ Patient expectations are more influenced by family, friends and prior experiences ▪ Most patients with LBP expect an X-ray to identify “the cause of pain.” ▪ Prior relationship with their physician correlates to the degree of patient satisfaction
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Opioids +/- Cognitive Behavioral Therapy (CBT) had no effect on improving perceptions of pain, fatigue, level of distress in patients with chronic LBP (J. of Pain Research Jan 2012)
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Younger patients have higher expectations before surgery with regard to symptom relief, mobility and reducing the impact the condition has on current and future life. Patients with more significant disability have higher expectations prior to (cervical) spine surgery. Do we ask the right questions?
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Do we understand the scores? Who is completing the questionnaire? Are happy patients more or less likely to complete the questionnaire? Should we “teach for the test?” Do we spend enough time listening to our patients?
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One large center study of 422 patients found that extent of improvement in quality of life and disability did not correlate with patient satisfaction scores. Study concluded that patient satisfaction is NOT a valid measure of overall quality or effectiveness of surgical spine care and should not be used as a proxy for overall quality, safety, or effectiveness of care. (Spine J, 2013 Sep;13(9):1006-12)
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How do we involve the public in the creation of CPG’s? ▪ Spine (2004) “Practice guidelines should pay more attention to the best way of discussing causes and diagnosis with patients and should involve them in decision making.” Have we included patients in the creations of CPGs in the last decade?
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▪ CPGs reviewed by AAPMR CPG committee in the area of back pain and Agree II score: ▪ NASS (Spinal Stenosis)1 ▪ NASS (Spondylolisthesis)1 ▪ AAOS (Sympt CF)3 ▪ APTA (CPG linked to ICF)1 The answer is NO!!!
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We know what patients want. We have an idea of patient expectations. Patient satisfaction scores do not correlate with quality of care. We have not done a good job of including patients (lay public) in the creation of CPGs. We are not “satisfying” patients because we are not creating realistic expectations and are not asking the right questions.
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Hoffman et al. Patients expectations of acute low back pain management. J Fam Prac 2013;14(7). Sanderson, Kristen, et al. Investigating patient expectations and treatment outcome in a chronic low back pain population.J of Pain Research Jan 2012 Verbeck J, et al. Patient expectations of treatment for back pain; a systematic review of qualitative and quantitative studeis. Spine 2004 Oct 15;29(20)2309-18 AAPMR website CPGs endorsed by the Academy
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Godil SS et al, Determining the quality and effectiveness of surgical spine care:patient satisfaction is not a valid proxy.Spine J, 2013 Sep; 13(9):1006-12 Mancuso, CA et al, Patients’ expectations of cervical spine surgery, Spine. 2014;39(14):1157- 1162 Bowling A, et al, The measurement of patients’ expectations for health care: a review and psychometric testing of a measure of patients’ expectations. Health Technol Assess, 2012 Jul:16(30):i-xii
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