RESUMEN
CONTEXT: Low back pain (LBP) is a common cause of disability in adults and primary care physicians (PCPs) are commonly the first medical practitioners to assess these patients. Despite this, PCPs often feel unprepared to make return to work (RTW) recommendations. AIMS: The purpose of our project was to develop RTW guidelines for patients with LBP in the form of an accessible and adaptable electronic medical records (EMR) integrated tool. SETTINGS AND DESIGN: All licensed physicians and physician extenders who see patients over the age of 18 years, presenting with acute LBP who are currently employed were eligible for participation. PCPs were randomized with and without the RTW guidelines and charts were reviewed to assess if PCPs made RTW recommendations. SUBJECTS AND METHODS: RTW guidelines were developed using the Oswestry LBP Disability Questionnaire and the Official Disability Guidelines and integrated into the EMR. STATISTICAL ANALYSIS USED: A Chi-square analysis was used to compare physicians in the interventional and control groups. RESULTS: Forty-four PCPs were randomized into the intervention group and 37 into the control group. In the intervention group, 301 patient encounters met the inclusion criteria for acute LBP. Of these, RTW recommendations were used in 7.3% encounters. Comparatively, there were 256 cases of LBP in the control group and RTW recommendations were offered in 1.6% of encounters (P < 0.001). CONCLUSION: This study showed that PCPs with access to the RTW guidelines in an EMR-integrated tool were significantly more likely to make such recommendations.
RESUMEN
CONTEXT: The extent to which patients take chronic pain medications as prescribed is not well studied, and there are no generally agreed-upon measures. The Quantitative Analgesic Questionnaire (QAQ) is a new instrument designed to comprehensively document patient-reported medication use, generate scores to quantify it (by individual drug, class, and/or overall), and compare it (qualitatively and/or quantitatively) to the regimen as prescribed. OBJECTIVES: The aim of this study was to describe the development and preliminary validation of the QAQ. METHODS: The QAQ was studied in a convenience sample of 149 HIV-infected participants. RESULTS: We found that the QAQ scores computed for participants' chronic pain medication regimens were valid based on their correlation with 1) patient-reported pain intensity (r = 0.38; P < 0.001) and 2) experienced pain management physicians' independent quantification of the regimens (r = 0.89; P < 0.001). The QAQ also demonstrated high interrater reliability (r = 0.957; P < 0.001). Detailed examination of the QAQ data in a subset of 34 participants demonstrated that the QAQ revealed suboptimal adherence in 44% of participants and contained information that would not have been gleaned from review of the medical record alone in 94%, including use of over-the-counter medications and quantification of "as needed" dosing. The QAQ also was found to be useful in quantifying change in the medication regimen over time, capturing a change in 50% of the participants from baseline to eight week follow-up. CONCLUSION: The QAQ is a simple tool that can facilitate understanding of patient-reported chronic pain medication regimens, including calculation of percent adherence and generation of quantitative scores suitable for estimating and tracking change in medication use over time.