Online Program

Plus ça change, plus c'est la même chose? Management of non-cancer pain in US nursing homes

Tuesday, November 5, 2013 : 12:50 p.m. - 1:10 p.m.

Kate L. Lapane, PhD, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
Brian Quilliam, PhD, College of Pharmacy, University of Rhode Island, Kingston, RI
Introduction: Pain is prevalent in nursing homes and lack of analgesic use among those with documented pain far too common. The Centers for Medicare & Medicaid Services (CMS) revised guidance for meeting compliance in the recognition and management of pain in nursing home residents (F-Tag 309) in 2009. Objectives: 1) To describe the extent to which pain and use of analgesics in US nursing homes has changed since 1992; 2) To explore potential improvements in pain management with implementation of revisions to the surveyors' interpretive guidelines for F-Tag 309 Methods: The Minimum Data Set version 2.0 provided information on daily pain and analgesic use. We identified studies evaluating pain management in US nursing homes in three time periods (1992-1995 (n=49,971); 1998-2000 (n=21,380); 2007-2009 (n=9,952). The implementation of revisions to the surveyors' interpretative guidelines for F-Tag 309 went into effect on March 31, 2009. Results: Pain prevalence was remarkably similar during each study period (26% 1992-1995; 29% 1998-2000; 25% 2007-2009). Estimates of prevalence of no analgesic use among residents with documented pain were also similar over time (25% 1992-1995; 25% 1998-2000; 23% 2007-2009). Pain was more likely to be documented in the period after revisions to surveyors guidelines were implemented. Increases in scheduled analgesic prescription were observed in the post-revision era. CONCLUSION: Little change in pain prevalence or reductions in absence of analgesic use among those with documented pain has been realized. However, revisions to the surveyors' interpretive guidelines may offer promise to improve pain documentation and management.

Learning Areas:

Biostatistics, economics
Public health or related laws, regulations, standards, or guidelines
Public health or related nursing
Public health or related public policy

Learning Objectives:
Describe prevalence of pain in long-term care (LTC) facilities in the past 20 years Evaluate short-term impact of changes to surveyors interpretative guidelines on pain management in nursing homes Compare use of analgesics over nearly two decades in US nursing homes

Keyword(s): Nursing Homes, Public Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have published extensively on pain management in nursing homes in peer reviewed journals over the last 15 years. I am a PhD level epidemiologist whose work focuses on medication use in older adults, and in particular in nursing homes settings.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Janssen Scientific Pain and Mental Health coauthors on papers related to pain in nursing homes and Independent Contractor (contracted research and clinical trials)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.