A mixed-methods evaluation of a nurse-pharmacist–managed pain clinic
Bibliographic record
Abstract
Background: Under-treatment of chronic pain within the community is a global problem. There is a growing interest to evaluate the role of nurses and pharmacists in chronic pain management with an aim to improve access to and quality of pain services. \nAim: The research presented in this thesis had two aims: first, to evaluate the effectiveness of pharmacist-led medication review in chronic pain management; second, to evaluate the impact of a community based nurse-pharmacist managed pain clinic. \nMethods: A systematic review and meta-analysis was conducted to evaluate the effectiveness of pharmacist-led medication review in chronic pain management. For the second aim, a mixed-methods study consisting of a quasi-experimental design and a qualitative descriptive design was undertaken. Pain intensity was the primary outcome. The secondary outcomes included: physical functioning; emotional functioning; quality of life; chronic pain grade and patient satisfaction. Patient satisfaction was evaluated using face-to-face, semi-structured qualitative interviews. \nResults: Of the 578 papers screened, five RCTs were included in the systematic review and three in the meta-analysis. Compared to the control, the meta-analysis found that patients in the intervention group had: a statistically significant reduction in pain intensity of 0.8 point (95% CI -1.28 to -0.36) and 0.7 point (95% CI -1.19 to -0.20) at 3-months and 6-months respectively; and 4.84 point (95% CI, -7.38 to -2.29) at 3-months and -3.82 point (95% CI, -6.49 to -1.14) at 6-months improvement in physical functioning. \nSeventy nine patients with a mean age of 46.5 years (SD ±14.4) took part in the quasi-experimental study. Thirty-six and 9 patients completed discharge and 3-month follow-up assessments respectively. Compared to baseline, statistically significant reductions were noted for two of the four outcome measures: pain intensity (P=0.02), and interference of pain with physical functioning (P=0.02) on discharge from the service. The majority of the patients were, in general, satisfied with the service. Four contributing factors to patient satisfaction were \nidentified: ample consultation time; in-depth specialised knowledge; listening and understanding to patients’ needs; and a holistic approach. \nConclusion: Community-based pain clinics managed by a nurse and pharmacist have the potential to improve chronic pain management in the community by providing timely access to a specialised pain service, ensuring safe and effective use of analgesics (medication reviews) and promoting self-management (patient education). Both pharmacist-led medication review and nurse-pharmacist managed pain clinics can reduce pain intensity and improve physical functioning The long term impact of the pain clinic could not be fully elucidated from this research as the planned follow-up data collection could not be completed due to decommissioning of the service.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.072 | 0.086 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.010 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".