Pathway Population: CHRONIC PAIN Pain and Quality of Life Pathway

PCBH Program Manual Appendix D PCBH Pathway Examples Pathway Population: CHRONIC PAIN “Pain and Quality of Life Pathway” Method of Identification: PCP: yes Screener: yes Other: none

PCP Role BHC Role RN Role Complete Pt Agreement Assessment Instrument Refer to BHC Yes Duke at initial BHC visit Yes* Refer to BHC Frequency of Assessment Registry Tracking Same Day Monthly Yes Plan Treatment Brief Intervention Registry Parameters Monthly QOL** Class 1. Describe pacing; 1. Agreement signed (and medication, yes/no) 2. Describe bull’s eye values 2. Assigned to class identification 3. UA frequency/status 4. Date of Agreement Violation 5. Three Chances start / stop

Monitor Outcomes Psycho-education Material Other Monthly QOL; pain agreement Bull’s-Eye Worksheet compliance Orientation to Class Yes Psycho-educational Class No Monthly Management Class Yes, QOL Class (with PCP in some cases), required by Pain Agreement *at request of the PCP **Quality of Life Class Pathway Population: TOBACCO CESSATION “Tobacco Free” Method of Identification PCP: yes Screener: no Other: none

PCP Role BHC Role RN Role Complete Pt Agreement Assessment Instrument Refer to BHC No Duke at initial BHC visit Yes* Refer to BHC Frequency of Assessment Registry Tracking Yes, Same Day N/A No Plan Treatment Brief Intervention** Registry Parameters 1. Assess Readiness Level Provide Cognitive Behavioral Therapy (CBT) None 2. Provide Support to Tobacco consistent with other evidence and other Users initiatives (e.g., stages of change, harm reduction, adds CBT to nicotine replacement / suppression products) Screens at all patient visits Provides relapse prevention support (“urge surf”, how to avoid “abstinence violation effect” Monitor Outcomes Psycho-education Material Other Assess and document Smoker’s Helpline (1-800-662-8866 and ? tobacco use website) Exam room posters Post exam room posters Orientation to Class Yes Psycho-educational Class Freedom from Smoking Monthly Management Class NO *at request of the PCP

Appendix D-Page 2