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      Health Care Systems Support to Enhance Patient-Centered Care: Lessons from a Primary Care-Based Chronic Pain Management Initiative

      research-article
      , MD, MPH, FACP , PhD, MPH , PhD, MPH , PhD , MBCHB, PhD, MBAcC, MRCGP , MA, LPC , RN, PhD, CNS , MD, MPH
      The Permanente Journal
      The Permanente Journal

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          Abstract

          Background

          Supporting day-to-day self-care activities has emerged as a best practice when caring for patients with chronic pain, yet providing this support may introduce challenges for both patients and primary care physicians. It is essential to develop tools that help patients identify the issues and outcomes that are most important to them and to communicate this information to primary care physicians at the point of care.

          Objective

          We describe our process to engage patients, primary care physicians, and other stakeholders in the context of a pilot randomized controlled trial of a patient-centered assessment process implemented in an everyday practice setting. We identify lessons on how to engage stakeholders and improve patient-centered care for those with chronic conditions within the primary care setting.

          Methods

          A qualitative analysis of project minutes, interviews, and focus groups was conducted to evaluate stakeholder experiences. Stakeholders included patients, caregivers, clinicians, medical office support staff, health plan administrators, an information technology consultant, and a patient advocate.

          Results

          Our stakeholders included many patients with no prior experience with research. This approach enriched the applicability of feedback but necessitated extra time for stakeholder training and meeting preparation. Types of stakeholders varied over the course of the project, and more involvement of medical assistants and Information Technology staff was required than originally anticipated.

          Conclusion

          Meaningful engagement of patient and physician stakeholders must be solicited in a well-coordinated manner with broad health care system supports in place to ensure full execution of patient-centered processes.

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          Author and article information

          Journal
          Perm J
          Perm J
          prjl
          The Permanente Journal
          The Permanente Journal
          1552-5767
          1552-5775
          2017
          03 April 2017
          : 21
          : 16-101
          Affiliations
          Physician Lead for Integrative Medicine at Kaiser Permanente Northwest and an Affiliate Investigator at the Center for Health Research in Portland, OR. E-mail: charles.elder@ 123456kpchr.org .
          Senior Investigator at the Kaiser Permanente Center for Health Research in Portland, OR. E-mail: lynn.debar@ 123456kpchr.org .
          Professor Emerita in the Department of Family and Community Medicine and Anthropology at the University of Arizona in Tucson. E-mail: ritenbau@ 123456email.Arizona.edu .
          Research Program Manager in the Science Programs Department of the Center for Health Research in Portland, OR. E-mail: maureen.h.rumptz@ 123456kpchr.org .
          Physician in the School of Community Medicine at the University of Bristol in the United Kingdom. E-mail: charlotte.patterson@ 123456bristol.ac.uk .
          Research Associate in the Behavior Assessment and Change Department at the Center for Health Research in Portland, OR. E-mail: allison.d.bonifay@ 123456kpchr.org .
          Director of the American Chronic Pain Associate in Rocklin, CA. E-mail: pcowan@ 123456theacpa.org .
          Assistant Professor at the School of Nursing at the University of Portland in OR. E-mail: lancaste@ 123456up.edu .
          Professor of Family Medicine and Internal Medicine at the Oregon Institute for Occupational Health Sciences at Oregon Health and Science University in Portland. He is also a Clinical Investigator at the Center for Health Research in Portland, OR. E-mail: deyor@ 123456ohsu.edu .
          Article
          PMC5391786 PMC5391786 5391786 16-101
          10.7812/TPP/16-101
          5391786
          28406791
          c95263bd-1573-4024-8a10-3fc9e974f30d
          © 2017 The Permanente Journal
          History
          Categories
          Original Research & Contributions: Special Report

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