Date of Award

Spring 5-27-2017

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Joseph Burkard, DNSc, CRNA

Abstract

Background
Veterans are disproportionately affected by chronic pain. Conventional pain management lacks emphasis on self-care and relies heavily on prescription opioids. Primary care providers (PCP) are able to educate veterans on self-care management; however, frequent follow-up is needed to improve overall pain and quality of life.

Objective
To implement a Nurse Practitioner (NP) telephone follow-up guided by the 5A’s framework among veterans with chronic pain in a primary care setting. This pilot evidence-based project (EBP) aimed to improve follow-up of self-care management in order to decrease pain, increase quality of life, and decrease pain medication use.

Materials & Methods
The pilot EBP took place at a single Veterans Affairs (VA) Primary Care clinic. The Institutional Review Board (IRB) at the VA and the University of San Diego approved this pilot study. Baseline data were retrieved among 14 veterans with chronic (>3 months) musculoskeletal pain. A monthly telephone follow-up using the 5A’s framework (ask, assess, advise, assist. arrange) was made which reinforced self-care, developed patient-centered goals, and established a follow-up plan. Outcome data were collected monthly including pain scores (Numeric Pain Rating Scale), quality of life scores (American Chronic Pain Association Scale), and number of pain medications. After 3 months, pre/post intervention data were compared and analyzed to evaluate project effectiveness.

Results
13 out of 14 veterans (93%) completed all 3 monthly telephone interventions. Average pain scores (NPRS) improved from 5.94 to 4.46, decreasing 1.44 from baseline (95% confidence interval, .605, 2.27) and was statistically significant at p < .003. Average quality of life (QOL) scores improved from 4.7 to 6.85, increasing 2.08 from baseline (95% confidence interval, 1.0, 3.15) and was statistically significant at p < .001. Average pain medications (PM) decreased from 2.21 to 2.14 and was not clinically or statistically significant at a p=.790.

Conclusion
A monthly telephone intervention emphasizing overall self-care management improved average pain and quality of life outcomes among chronic pain veterans. Telephone follow-up may serve as a substitute for routine chronic pain follow-up visits or as a supplement to improve access to quality care. Future research is warranted.

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