Effectiveness of a Rural Emergency Department (ED)-Based Pain Contract on ED Visits Among ED Frequent Users

Caring for patients with chronic pain in emergency departments (EDs) can be particularly challenging, for both patients and physicians.

This study sought to determine, in a rural setting, the effect of an ED-based pain contract on the rate of ED visits among patients with frequent visits for pain not related to cancer.

This is a multi-ED, retrospective, before-and-after chart review assessing the effect of a rural ED-based pain contract on the frequency of ED visits. The study setting consisted of four rural EDs representing over 85,000 annual visits. Medical records of patients eligible for a standardized pain contract during a 10-year period (December 2005-December 2015) were reviewed. Only visits involving complaints of pain were included. The number of visits during the year prior to contract initiation was compared with the number of visits during the year after enrollment, using a paired t-test.

We enrolled 314 patients, 185 (59%) of whom were female. The study group's median age was 48 years. The mean number of ED visits was 12.4 visits (95% confidence interval [CI] 11.5-13.3) 1 year prior to the pain contract and 6.5 (95% CI 5.6-7.3) 1 year afterward (p < 0.0001). The mean number of ED visits decreased by 6.0 (95% CI 5.0-7.2).

A pain contract protocol was associated with a significant reduction in the number of ED visits to multiple rural EDs.