The Efficacy of a Brief Behavioral Health Intervention for Managing High Utilization of ED Services by Chronic Pain Patients


      Patients with chronic pain continue to seek medical care from emergency departments nationwide despite the fact that an emergency department is a less-than-optimal environment for meeting their specific and specialized needs. As the scientific community has gained a more sophisticated understanding of the mechanisms that contribute to the development and maintenance of chronic pain, the central role of psychological factors have emerged. Therefore, an ED-based, behavioral health intervention for chronic pain patients is needed to better serve this population and to help hospitals provide cost effective treatment at the appropriate level of care.


      The setting was a 40-bed, acute-care hospital with a 15-bed emergency department seeing 16,500 patients annually. All participants were chronic pain patients utilizing the emergency department for pain management. This study was a program evaluation utilizing a quasi-experimental, retrospective, pre-test/post-test, split-plot design.


      A repeated measures analysis of variance (ANOVA) was used to compare high-utilizers (>4 emergency department visits in 6 months) to low utilizers in total ED visits 6 months before and after the intervention. The low utilizers mean ED visits remained stable before and after the intervention while the high utilizers showed a decrease in ED utilization. This differential response between groups was statistically significant (P < .05).


      This study suggests that an ED-based behavioral health consultation may be useful for reducing high utilization of ED services by some chronic pain patients, particularly those who consume the most services.
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      Jonathan Woodhouse is Doctoral Student, Department of Clinical Psychology, George Fox University, Newberg, OR.


      Mary Peterson is Assistant Professor, Graduate Department of Clinical Psychology, George Fox University, Newberg, OR.


      Clark Campbell is Professor of Psychology and Director of Clinical Training, Department of Clinical Psychology, George Fox University, Newberg, OR.


      Kathleen Gathercoal is Director of Research and Professor of Psychology, Department of Clinical Psychology, George Fox University, Newberg, OR.