Long-term effectiveness of a multifaceted intervention on pain management in a walk-in clinic.

BACKGROUND Pain is a common complaint of patients attending walk-in clinics, but timely and appropriate pain management is often lacking. AIM To evaluate the impact of a multifaceted intervention on pain management. DESIGN Prospective interventional study. METHODS Three cross-sectional surveys were conducted: before, 4 months after and 14 months after a multifaceted intervention at the medical walk-in clinic of a university hospital. The intervention included both educational activities and structural changes. Use of recommended pain management procedures, pain relief and overall assessments of pain treatment and health professionals' attitudes were assessed using patient questionnaires, collected by mail. History of pain, records of pain intensity and use of pain medication were extracted from medical files. RESULTS We analysed 1409 medical files and 695 questionnaires of patients presenting with pain. Documentation of pain intensity and administration of pain medication at the walk-in clinic improved significantly 14 months after the intervention (7% vs. 53% and 17% vs. 27%, respectively, p<0.001) and pain medication was more often administered by the oral route (14% vs. 23%, p<0.001). However, no change was observed for complete pain relief (40% vs. 39%, p=0.92) or patients' overall assessments of pain management. DISCUSSION The intervention improved adherence to recommended procedures, even in the longer term, but did not result in better patient outcomes. Continuing efforts are needed to help health professionals improve pain management in out-patient care.