Design, Implementation, and Evaluation of an Integrative Pain Management Program in a Primary Care Safety-Net Clinic.

OBJECTIVE: To design, implement, and evaluate a comprehensive Integrative Pain Management Program (IPMP) for patients with chronic pain in a safety-net primary care clinic. DESIGN: We used a quality improvement "Plan Do Study Act" (PDSA) framework to design, refine, and evaluate an integrative chronic pain program. SETTING: An urban federally qualified health center located in a community with high rates of chronic pain, substance use, and opioid overdose. SUBJECTS: Eligible participants included individuals with pain for greater than 3 months who were prescribed opioid therapy. OUTCOME MEASURES: We designed IPMP using a PDSA framework that promotes continuous evaluation and adaptation of the program to meet the needs of the clinical system. We assessed feasibility and acceptability with program referrals and attendance and evaluated program satisfaction. RESULTS: The IPMP delivered a 12-week group-based intervention that involved group support, education on pain etiology and treatments, movement-based interventions, mindfulness-based therapies, acupuncture, and massage therapy. One hundred forty-six patients were referred to IPMP; 58 individuals participated in one of the first three cohorts of the program. Sixty-two percent of participants attended at least half of the sessions. Staff and participants reported high levels of satisfaction with IPMP and demand for longitudinal services. CONCLUSIONS: An IPMP delivered within a safety-net primary care clinic could be implemented in a way feasible and acceptable to staff and participants with the support of the local health care system. The application of a PDSA cycle allowed for rigorous implementation and evaluation of a multimodal pain program. Quality improvement frameworks are a strategy to improve and expand the delivery of high-quality patient-centered integrative pain treatments.

How a cancer education group serves the underserved: 'family' ties and battling cancer.

OBJECTIVE: Socially disadvantaged cancer patients have unmet educational needs, but we know little about how educational groups might help. This exploratory study examines how a group education program met underserved patients' needs. METHODS: We examined a program for US patients in a safety-net hospital that featured English and Spanish language groups. We collected data from 54 group sessions over 28 months, including information on participant demographics, attendance, and satisfaction. Qualitative field notes collected by trained observers were analyzed via a grounded-theory approach to examine group dynamics. RESULTS: Participants were underserved, had diverse disease sites and race/ethnicity, and reported that groups met their needs. Emergent analysis identified two themes related to group dynamics. First, members identified with each other as a fictive family, although the meaning of "family" differed in the groups. Second, groups focused on battling cancer not adjusting to life as a survivor-a focus that impaired participants' ability to discuss coping strategies for managing negative feelings. CONCLUSION: Fictive 'family' engages participants. The emphasis on 'family' and resistance to coping strategies may reflect participants' social disadvantages. PRACTICE IMPLICATIONS: Groups for the underserved should strive to create a 'family' and may have difficulty helping participants cope with their illness.