Abstract
Objectives
To determine whether an intervention based on education and professional support to
nursing home (NH) staff would decrease the number of residents with a pain complaint,
and to determine whether the intervention would improve pain management.
Design
Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong
intervention group consisting in audit, feedback, and collaborative work on quality
indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting
in audit and feedback only.
Setting
One hundred fifty-nine NHs located in France.
Participants
A subgroup of 3722 residents.
Measures
Information on pain complaint and pain-related covariates at the resident-related
and at the NH level were recorded by NH staff at baseline and 18 months later. These
covariates were included in a mixed-effects logistic regression on resident's pain
complaint. Pain management was compared between intervention groups by chi-square
tests.
Results
A greater reduction of residents with a pain complaint after the strong intervention
(odds ratio 0.69, 95% confidence interval 0.53, 0.90) and a better pain management
(47.6% gold standard, vs 30.6% in the LIG, P < .001) than controls.
Conclusion/Implications
Combining educational and organizational measures, evaluating pain as a patient-reported
outcome and as a process endpoint, and implementing a broad-spectrum intervention
were original approaches to improve quality of care in NHs. Our results support nonspecific,
collaborative, educational, and organizational interventions in NHs to decrease residents'
pain complaint and improve pain management.
Keywords
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Article info
Footnotes
The authors declare no conflicts of interest.
The IQUARE study was funded by a grant from the Regional Agency of Health of the Midi-Pyrénées region (Agence Régionale de Santé–Midi-Pyrénées). The funder contributed to data collection. The funder had no influence on the analysis and interpretation of data, or on the preparation, review, or approval of the manuscript.
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
