PhD Student Nikpour and Dean Broome Submit NCSBN Fellowship Application

Kudos to PhD student Jacqueline Nikpour and her sponsor Marion Broome, dean and Ruby Wilson Professor of Nursing for Duke University School of Nursing; vice chancellor for Nursing Affairs for Duke University; and associate vice president for Academic Affairs for Nursing for Duke University Health System; for the submission of her NCSBN Fellowship application entitled "Influence of Provider Type and Patient Characteristics on Pain Management in Veterans with Lower Back Pain." This proposal requests funds for a one-year period with a start date of March 15, 2020.

Background: Chronic musculoskeletal pain is the third highest category of all health spending, and is a significant issue among veterans. Complex co-existing issues in the chronic pain management of veterans include the opioid epidemic and difficulty accessing timely primary care. Primary care nurse practitioners (PCNPs) are documented high-quality providers of chronic pain management who represent a solution to expanding access to care while maintaining quality and even reducing cost. However, regulatory barriers exist that limit the ability of PCNPs to manage chronic pain both within the VA and in private practice. Furthermore, the majority of extant literature on pain management prescribing patterns has been physician-centric and none has focused on opioid prescribing in the VA, despite the growing role of PCNPs and the impact of chronic pain on veterans. While early evidence indicates that PCNPs may be less likely than other providers to utilize opioid medications as the primary form of pain management and more likely to use non-opioid and multi-modal therapies, minimal in-depth evidence exists on the practice patterns of PCNPs.

Aim: To identify the utilization of opioid medications, non-opioid medications, and non-pharmacologic strategies of chronic pain management, between PCNPs and other providers (physicians and physicians’ assistants)

Methodology: We will utilize a national Veterans Administration database from 2012 to 2013 to analyze the utilization of opioid medications, non-opioid medications, and non-pharmacologic strategies between physicians, PCNPs, and physicians’ assistants (PAs) for patients with an ICD-9 code for lower back pain. This dataset includes data from the Consumer Assessment of Healthcare Providers and Systems (CAHPS), which identifies the specific provider responsible for each visit, and has been linked to the Veterans Administration Corporate Data Warehouse (CDW) that houses patient level data (such as chronic pain treatments and referrals) and provider characteristics, including provider type.