2020
“Asking Is Never Bad, I Would Venture on That”: Patients’ Perspectives on Routine Pain Screening in VA Primary Care
Giannitrapani KF, Haverfield MC, Lo NK, McCaa MD, Timko C, Dobscha SK, Kerns RD, Lorenz KA. “Asking Is Never Bad, I Would Venture on That”: Patients’ Perspectives on Routine Pain Screening in VA Primary Care. Pain Medicine 2020, 21: 2163-2171. PMID: 32142132, DOI: 10.1093/pm/pnaa016.Peer-Reviewed Original ResearchConceptsPain screeningPrimary carePatient's perspectiveVA health care systemPain management strategiesVA primary careVeterans Health AdministrationMental health concernsHealth care systemRoutine carePatient recallPatients' perceptionsPatient recommendationsPainRoutine painHealth AdministrationHealth concernCare systemMental distressCarePatientsPsychological painScreeningTheme 1Theme 2
2018
Testing implementation facilitation of a primary care-based collaborative care clinical program using a hybrid type III interrupted time series design: a study protocol
Midboe AM, Martino S, Krein SL, Frank JW, Painter JT, Chandler M, Schroeder A, Fenton BT, Troszak L, Erhardt T, Kerns RD, Becker WC. Testing implementation facilitation of a primary care-based collaborative care clinical program using a hybrid type III interrupted time series design: a study protocol. Implementation Science 2018, 13: 145. PMID: 30486877, PMCID: PMC6262952, DOI: 10.1186/s13012-018-0838-2.Peer-Reviewed Original ResearchMeSH KeywordsAnalgesics, OpioidCooperative BehaviorEvidence-Based PracticeHumansImplementation ScienceInservice TrainingInterrupted Time Series AnalysisPain ManagementPractice Patterns, Physicians'Primary Health CareProgram EvaluationResearch DesignUnited StatesUnited States Department of Veterans AffairsWork EngagementConceptsCollaborative care interventionVeterans Health AdministrationImplementation facilitationPrimary careCare interventionsHigh-dose opioid therapyMorphine equivalent daily doseVHA health care systemClinical programsImplementation facilitation strategyOutpatient opioid prescriptionsOpioid prescribing practicesPain management servicesCollaborative care programEquivalent daily dosePrimary care clinicsPrimary care providersRE-AIM frameworkInterrupted time seriesOpioid overdose crisisHealth care systemInterrupted time series designEligible patientsMedication taperingOpioid therapyA Brief, Integrated, Telephone-Based Intervention for Veterans Who Smoke and Have Chronic Pain: A Feasibility Study
Driscoll MA, Perez E, Edmond SN, Becker WC, DeRycke EC, Kerns RD, Bastian LA. A Brief, Integrated, Telephone-Based Intervention for Veterans Who Smoke and Have Chronic Pain: A Feasibility Study. Pain Medicine 2018, 19: s84-s92. PMID: 30203011, DOI: 10.1093/pm/pny144.Peer-Reviewed Original ResearchConceptsChronic painEvidence-based smoking cessationWorst pain intensity scorePain intensity scoresTelephone-delivered interventionChronic pain reportVA healthcare systemCo-occurring smokingCurrent smokingPain intensityPain outcomesSmoking cessationTelephone interventionPrimary carePain reportsVeteran populationSmokingIntensity scoresMeaningful improvementsStudy participantsPilot studyFunctional interferenceHealthcare systemInterventionPainDuration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care
Barry DT, Marshall BDL, Becker WC, Gordon AJ, Crystal S, Kerns RD, Gaither JR, Gordon KS, Justice AC, Fiellin DA, Edelman EJ. Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care. Drug And Alcohol Dependence 2018, 191: 348-354. PMID: 30176548, PMCID: PMC6596307, DOI: 10.1016/j.drugalcdep.2018.07.008.Peer-Reviewed Original ResearchConceptsPrescription opioid receiptPrescription opioidsMedical careOpioid receiptVeterans Health Administration primary careNonmedical useMultivariable Cox modelInfectious disease clinicProspective cohort studyProportional hazards regressionPrescription opioid medicationsPublic health problemSubstance use disordersMedication-related characteristicsOpioid therapyOpioid medicationsOpioid prescriptionsCohort studyDisease clinicMedian ageHazards regressionEligible participantsPrimary careRisk factorsIncidence rateAssociation Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy
Carey EP, Nolan C, Kerns RD, Ho PM, Frank JW. Association Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy. Journal Of General Internal Medicine 2018, 33: 38-45. PMID: 29633137, PMCID: PMC5902343, DOI: 10.1007/s11606-018-4324-y.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyNon-pharmacologic treatmentsFacility-level variationNon-opioid medicationsChronic painOpioid therapyTreatment modalitiesVeterans Health Administration facilitiesPatient-reported painChronic pain treatmentChronic pain careImproved patient outcomesUtilization patternsOpioid treatmentPrior calendar yearMedication utilizationPatient characteristicsPain treatmentPain careKey ResultsAmongPrimary carePatient outcomesPainGreater utilizationAdministration facilitiesVeteran Experiences Seeking Non-pharmacologic Approaches for Pain
Giannitrapani K, McCaa M, Haverfield M, Kerns RD, Timko C, Dobscha S, Lorenz K. Veteran Experiences Seeking Non-pharmacologic Approaches for Pain. Military Medicine 2018, 183: e628-e634. PMID: 29590422, DOI: 10.1093/milmed/usy018.Peer-Reviewed Original ResearchConceptsNon-pharmacologic approachesUS military veteransPatient-centered pain careVA health care systemManagement of painNumeric rating scalePrimary care clinicsMilitary veteransPain intensity ratingsSpecific access barriersVA healthcare systemMulti-level barriersHealth care systemVeterans' experiencesFuture implementation effortsPain screeningCare clinicsPain carePrimary careCare coordinationPain studiesPainPain experienceVeterans' knowledgeFemale veterans
2016
Improving pain care through implementation of the Stepped Care Model at a multisite community health center
Anderson DR, Zlateva I, Coman EN, Khatri K, Tian T, Kerns RD. Improving pain care through implementation of the Stepped Care Model at a multisite community health center. Journal Of Pain Research 2016, Volume 9: 1021-1029. PMID: 27881926, PMCID: PMC5115680, DOI: 10.2147/jpr.s117885.Peer-Reviewed Original ResearchPrimary care providersPain knowledge scoresCommunity health centersStepped care modelPain careHealth centersCare modelMultisite community health centerFederally Qualified Health CentersOpioid treatment agreementsQualified health centersUrine drug screensDocumentation of painHealth Services frameworkSafety-net practicesElectronic health recordsOpioid prescribingChart reviewPain managementPain outcomesPain treatmentChronic painPain assessmentTreatment agreementsPrimary careInitial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy
Becker WC, Fiellin DA, Black AC, Kostovich CT, Kerns RD, Fraenkel L. Initial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy. The Journal Of Rehabilitation Research And Development 2016, 53: 127-136. PMID: 27006339, PMCID: PMC4806533, DOI: 10.1682/jrrd.2014.11.0285.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyPatient-reported instrumentOpioid therapyFurther item reductionIneffective medicationsClinical outcomesPrimary careFrequent reassessmentPatient comprehensionItem reductionGold standardEfficacyTherapyInterdisciplinary teamLevel checksCognitive interviewsMisuseHarmMedicationsPatients
2014
Integrating Interdisciplinary Pain Management into Primary Care: Development and Implementation of a Novel Clinical Program
Dorflinger LM, Ruser C, Sellinger J, Edens EL, Kerns RD, Becker WC. Integrating Interdisciplinary Pain Management into Primary Care: Development and Implementation of a Novel Clinical Program. Pain Medicine 2014, 15: 2046-2054. PMID: 25234837, DOI: 10.1111/pme.12554.Peer-Reviewed Original ResearchConceptsPrimary careRapid Process Improvement WorkshopCare servicesCommunity-based outpatient clinicsInterdisciplinary pain programPain management resourcesSystems-level gapsInterdisciplinary pain managementVeterans Health AdministrationLarge healthcare systemSystems-based interventionsEvidence of safetyInterprofessional groupStudy-Act approachPain clinicPain managementPain programOutpatient clinicImproved outcomesInterdisciplinary clinicMedical CenterProvider satisfactionHealth AdministrationPDSA cyclesMisuse problemsA Partnered Approach to Opioid Management, Guideline Concordant Care and the Stepped Care Model of Pain Management
Dorflinger L, Moore B, Goulet J, Becker W, Heapy AA, Sellinger JJ, Kerns RD. A Partnered Approach to Opioid Management, Guideline Concordant Care and the Stepped Care Model of Pain Management. Journal Of General Internal Medicine 2014, 29: 870-876. PMID: 25355083, PMCID: PMC4239281, DOI: 10.1007/s11606-014-3019-2.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid risk mitigation strategiesOpioid therapyGuideline-concordant careVeterans Health AdministrationPain managementStepped care modelOpioid managementChronic painPain carePrimary carePractice guidelinesCare modelHigh-dose opioidsKey ResultsThe proportionProportion of patientsNon-opioid analgesicsClinical practice guidelinesCommon presenting problemManagement of veteransPerformance improvement outcomesClinical research teamInteractive educational strategiesFour-year study periodConcordant careGuideline-Concordant Management of Opioid Therapy Among Human Immunodeficiency Virus (HIV)-Infected and Uninfected Veterans
Gaither JR, Goulet JL, Becker WC, Crystal S, Edelman EJ, Gordon K, Kerns RD, Rimland D, Skanderson M, Weisberg DF, Justice AC, Fiellin DA. Guideline-Concordant Management of Opioid Therapy Among Human Immunodeficiency Virus (HIV)-Infected and Uninfected Veterans. Journal Of Pain 2014, 15: 1130-1140. PMID: 25152300, PMCID: PMC4253900, DOI: 10.1016/j.jpain.2014.08.004.Peer-Reviewed Original ResearchConceptsCurrent substance use disorderGuideline-concordant careOpioid therapyUrine drug testsHuman immunodeficiency virusSubstance use disordersUninfected patientsImmunodeficiency virusUse disordersPatient/provider characteristicsPrimary care provider visitsVeterans Affairs/DepartmentGuideline-concordant managementDrug testsCare concordantGuideline concordanceUninfected veteransProvider visitsPatient characteristicsPatient groupPrimary careClinical guidelinesPain medicineProvider characteristicsPatientsDevelopment and application of an electronic health record information extraction tool to assess quality of pain management in primary care
Dorflinger LM, Gilliam WP, Lee AW, Kerns RD. Development and application of an electronic health record information extraction tool to assess quality of pain management in primary care. Translational Behavioral Medicine 2014, 4: 184-189. PMID: 24904702, PMCID: PMC4041928, DOI: 10.1007/s13142-014-0260-5.Peer-Reviewed Original ResearchPrimary care settingPain managementChronic painPain carePrimary careCare settingsGuideline-concordant carePrimary care providersCommon presenting problemPain expertsInter-rater reliabilityCare providersCarePresenting problemInterdisciplinary panelPainFinal toolPilot testingPresence of indicatorsSettingExtraction toolQuality indicators
2013
A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care
Becker WC, Fraenkel L, Kerns RD, Fiellin DA. A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care. Journal Of General Internal Medicine 2013, 28: 1364-1367. PMID: 23568187, PMCID: PMC3785661, DOI: 10.1007/s11606-013-2422-4.Peer-Reviewed Educational MaterialsConceptsOpioid prescribingLong-term opioid therapyMulti-modal treatment planAppropriate opioid prescribingOpioid analgesic therapyPatient-reported safetyEvidence-based algorithmOpioid therapyOptimize therapyAnalgesic therapyChronic painPotent medicationsInadequate efficacyPrimary careQuality improvement workPatient sufferingMild toxicityTreatment planScant dataTherapyPrescribingEfficacyPatientsOutcomesToxicity
2006
The Prevalence and Age-Related Characteristics of Pain in a Sample of Women Veterans Receiving Primary Care
Haskell SG, Heapy A, Reid MC, Papas RK, Kerns RD. The Prevalence and Age-Related Characteristics of Pain in a Sample of Women Veterans Receiving Primary Care. Journal Of Women's Health 2006, 15: 862-869. PMID: 16999642, DOI: 10.1089/jwh.2006.15.862.Peer-Reviewed Original ResearchConceptsWomen veteransPain problemsPrimary careHealth clinicsHealth centersHigh prevalenceVA women’s health clinicAnalgesic medication useOngoing pain problemsPrevalence of painMental health visitsAverage pain intensityCharacteristics of painWomen's health clinicWomen's health centersPain intensity levelsPain prevalenceAnalgesic medicationPain sitesPain statusHealth visitsMedication usePain intensityPain treatmentRoutine appointments
2005
Intersession coping skill practice mediates the relationship between readiness for self-management treatment and goal accomplishment
Heapy A, Otis J, Marcus KS, Frantsve LM, Janke E, Shulman M, Bellmore W, Kerns RD. Intersession coping skill practice mediates the relationship between readiness for self-management treatment and goal accomplishment. Pain 2005, 118: 360-368. PMID: 16289803, DOI: 10.1016/j.pain.2005.09.004.Peer-Reviewed Original ResearchConceptsSelf-management treatmentCognitive behavioral therapySelf-management approachPain treatmentChronic painVA primary care clinicsPrimary care clinicsPain ReadinessCare clinicsPain StagesPatient readinessPrimary careImproved outcomesTreatment benefitTreatment goalsSkills practicePractice recommendationsAdherence ratingsAdherenceChange QuestionnairePSOCQPainPatientsTreatmentSelf-efficacy ratingsIdentifying the Activities Affected by Chronic Nonmalignant Pain in Older Veterans Receiving Primary Care
Duong BD, Kerns RD, Towle V, Reid MC. Identifying the Activities Affected by Chronic Nonmalignant Pain in Older Veterans Receiving Primary Care. Journal Of The American Geriatrics Society 2005, 53: 687-694. PMID: 15817018, DOI: 10.1111/j.1532-5415.2005.53220.x.Peer-Reviewed Original ResearchConceptsChronic nonmalignant painNonmalignant painChronic painDaily livingAverage pain intensity scoreOlder personsOlder primary care patientsVeterans Affairs Medical CenterPain intensity scoresPain-related disabilityPrimary care patientsPrimary care practicesProportion of participantsCross-sectional surveyCare patientsPrimary careInstrumental activitiesMedical CenterOlder veteransPhysical activityPainCare practicesIntensity scoresOlder individualsRecreational activities
2004
Identification of Strategies Used to Cope with Chronic Pain in Older Persons Receiving Primary Care from a Veterans Affairs Medical Center
Barry LC, Kerns RD, Guo Z, Duong BD, Iannone LP, Reid MC. Identification of Strategies Used to Cope with Chronic Pain in Older Persons Receiving Primary Care from a Veterans Affairs Medical Center. Journal Of The American Geriatrics Society 2004, 52: 950-956. PMID: 15161460, DOI: 10.1111/j.1532-5415.2004.52263.x.Peer-Reviewed Original ResearchConceptsVeterans Affairs Medical CenterChronic painOlder personsAnalgesic medicationMedical CenterOlder primary care patientsChronic noncancer painCognitive coping methodsTrauma-related painCross-sectional telephone surveyPrimary care patientsPrimary care practicesProportion of participantsNoncancer painPain characteristicsCare patientsMusculoskeletal causesPrimary carePainActivity restrictionCare practicesMultivariate analysisAscertain factorsOlder populationCoping strategies
2003
Functional self-efficacy and pain-related disability among older veterans with chronic pain in a primary care setting
Barry LC, Guo Z, Kerns RD, Duong BD, Reid M. Functional self-efficacy and pain-related disability among older veterans with chronic pain in a primary care setting. Pain 2003, 104: 131-137. PMID: 12855322, DOI: 10.1016/s0304-3959(02)00471-2.Peer-Reviewed Original ResearchConceptsPain-related disabilityChronic painOlder veteransVA Connecticut Healthcare SystemPrimary care settingMean agePotential confoundersPrimary careCare settingsIndependent factorsPainWest HavenRestricted activityPast monthSelf-Efficacy QuestionnaireMore daysHealthcare systemMost participantsDisabilitySelf-efficacy groupVeteransParticipantsConfoundersYearsPrevalence
2002
Pain-Related Disability Among Older Male Veterans Receiving Primary Care
Reid MC, Guo Z, Towle VR, Kerns RD, Concato J. Pain-Related Disability Among Older Male Veterans Receiving Primary Care. The Journals Of Gerontology Series A 2002, 57: m727-m732. PMID: 12403801, DOI: 10.1093/gerona/57.11.m727.Peer-Reviewed Original ResearchConceptsPain-related disabilityHigh pain-related disabilityPresence of painOlder male veteransPain intensityPrimary careDepressive symptomsMale veteransModerate pain-related disabilityOlder personsVeterans Affairs primary care clinicsEpidemiologic Studies Depression ScaleNumeric rating scalePrimary care clinicsLow back painCross-sectional studyMost daysPain characteristicsOne-unit increaseBack painCare clinicsSubstantial disabilityModifiable factorsOlder veteransPainCoping strategies and their associations with levels of disability or pain, among older veterans receiving primary care
Reid M, Barry L, Kerns R, Duong B, Concato J. Coping strategies and their associations with levels of disability or pain, among older veterans receiving primary care. Journal Of Clinical Epidemiology 2002, 55: 629. DOI: 10.1016/s0895-4356(02)00420-1.Peer-Reviewed Original ResearchChronic non-cancer painNon-cancer painLevel of disabilityChronic painSelf-reported effectivenessOlder personsPrimary careOlder veteransMedication usePain intensityComorbid conditionsMean ageCoping strategiesPainEligibility criteriaPsychological statusMultivariate analysisTelephone interviewsCold modalitiesLow levelsEligibility statusDisabilityReduced levelsPatientsPositive association