Patient satisfaction in academic pain centers: How do we compare?
The United States is currently in the midst of an opioid epidemic with an explosion of opioid related overdoses and deaths. Prescriptions for opioids have quadrupled since 1999 with the United States consuming 90% of the world's opioids (1). Patient satisfactions is often used as a health care quality metric. In assessing patient satisfaction, these surveys often query patients' experience of the pain management. In addition, the Joint Commission and Agency for Healthcare Research and Quality promoted "pain as the fifth vital sign" which may have led to the notion that patients should be pain free. The association between pain management and patient satisfaction may place physicians in a difficult position between prescribing opioids and facing disappointed patients who believe that pain management equates to opioid prescribing. Academic pain management centers often are referred the most difficult patients to treat as they may have failed other treatments already and are under the impression they are being referred for opioid management. We question therefore whether academic pain management centers are in a unique position to be cast negatively on patient satisfaction surveys secondary to issues related to opioid prescribing.
The opioid epidemic in the United States must be addressed in order to diminish the senseless loss of life that is occurring in staggering numbers. In order to address this epidemic we must curtail incentives for over prescribing and educate patients that pain management does not equate to elimination pain but instead increased function and decreasing pain to tolerable levels. We must understand that patient satisfaction does not equate to better outcomes. A prospective cohort study from 2000-2007 indicated that while patient satisfaction was associated with decreased emergency room visits, it actually led to increased in-patient admissions, higher overall healthcare and prescription drug costs, and increased mortality (2). Recently there has been progress to revise questions such as "how often did the provider do everything in their power to control your pain" from patient satisfaction surveys. These revisions combined with better resources for patient education may help to turn the tide. Academic pain management centers are in the forefront of this process.
1. Adams J. What are the state governments doing to combat the opioid abuse epidemic? Testimony presented to the US House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations. 2015 Available at http://docs.house.gov/meetings.IF/IF02/20150521/103501/HHRG-114-IF02-Wstate-AdamsJ-20150521.pdf.Accessed Feb 29, 2016.
2. Fenton J. The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures, and mortality. Acrch Int Med. 2012; 172(5): 405-411.