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Early
Detection of Issues Leading to Chronic Conditions
While the primary focus is getting patients back to work, the
costs associated with patients turning chronic, dictates that the highest
priority should be finding the 10-15% of patients who are at risk of
becoming chronic, and treating them intensively.
Identifying and addressing these issues as early as possible, minimizes
return-to-work time, minimizes chronic progression/disability and
minimizes total cost. Using an Electronic
Patient Interview is a proactive, cost-effective way for clinicians to find out about these underlying issues
as early as possible.
The ACOEM Occupational Medicine Practice Guidelines (2nd ed) state:
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“In patients with chronic pain, psychological reactions to the pain become the major contributors to impaired functioning.” (p 108)
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“If personal or psychosocial factors are contributing to delayed recovery, psychological, psychiatric, or other behavioral health intervention is more appropriate than continuing medication, physical therapy, or surgery.” (p. 87)
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The Guidelines also recommend that pain symptoms be tracked over the course of treatment. (p. 126)
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The Guideline algorithms recommend that all patients undergo a psychological assessment at 4 to 6 weeks if they are not progressing in treatment, and if pain complaints cannot be explained by objective medical findings. The Guidelines also suggest that prior to lumbar surgery, clinicians should consider a referral for psychological screening, to improve surgical outcomes (p. 306) .
Primary
Indicators
During the acute and sub-acute stages of an injury, pain &
functional complaints should be decreasing and disability &
psychological factors should not be an issue. Automatically
screening for these primary indicators (pain every visit,
functional complaints/disability/psych at re-evaluation visits) is
a cost-effective way for clinicians to monitor patient progress
and show medical necessity. Excessive severity in one or
more of these measures can also be used to automatically trigger
more in-depth screening for chronic condition indicators.
In-depth assessment of patients at risk
Whether initially evaluating a patient or checking them at a
re-evaluation, when triggered, assessment for issues leading to
chronic conditions should at a minimum measure the severity of pain, functional
complaints/disability, depression, anxiety and somatic complaints,
as well as flag key critical items. Specifically, Sleep
Disorder, PTSD/Dissociation, Anxiety/Panic, Psychosis, Vegetative
Depression, Satisfaction with Care, Chemical Dependency, Home Life
Problems, Perceived Disability, Compensation Focus, Doctor
Dissatisfaction, Pain Fixation, Random Responding, Death Anxiety,
and Suicidal Ideation, are all items that should be monitored. An automated assessment, such as the
BBHITM
2,
can provide all this information with basically no additional work
by you or your staff.
More than just a clinical tool
Clinical View -
Interview
patients electronically before their visit,
enabling trended reports like the BBHI2;
computed, summarized and in your hands before you start the visit. You utilize your patients as a resource
for data entry and the system reports the results with
effectively no additional burden on your staff.
Outcomes -
Adding a few additional questions to log standard categorical
information, and treatment/tracking protocol information,
standard clinical data can be aggregated to show protocol-based
outcomes, as well as provide data for Evidence-Based Medicine (EBM)
analysis.
Performance -
In addition to protocol-based outcomes, aggregate patient feedback
can be collected around perceived outcome, Quality-of-Life (QoL)
and satisfaction, and compared to regional and national norms to
gage how well your practice and its providers are performing.
Please Contact
Us to learn more or discuss how we can help in your
Occupational Medicine setting.
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