Introduction Primary care providers are on the front lines of chronic pain management, with many reporting frustration, low confidence, and dissatisfaction in handling the complex issues associated with chronic pain care. Given the importance of their role and reported inadequacies and dissatisfaction in managing this challenging population, it is important to understand the perspectives of primary care providers when considering approaches to chronic pain management. This qualitative descriptive study aimed to comprehensively summarize the provider challenges and suggestions to improve chronic pain care in military primary care settings. Materials and Methods Semi-structured interviews with 12 military primary care providers were conducted in a single U.S. Army medical center. All interviews were audio-recorded and lasted between 30 and 60 minutes. Interview transcripts were analyzed using ATLAS 9.0 software. Narratives were analyzed using a general inductive approach to content analysis. The Framework Method was used to organize the codes and emergent categories. All study procedures were approved by the Institutional Review Board of the University of Washington. Results Four categories captured providers’ challenges and suggestions for improving chronic pain care: (1) tools for comprehensive pain assessment and patient education, (2) time available for each chronic pain appointment, (3) provider training and education, and (4) team-based approach to chronic pain management. Providers suggested use of the Pain Assessment Screening Tool and Outcomes Registry, more time per visit, incorporation of chronic pain care in health sciences curriculum, consistent provider training across the board, insurance coverage for complementary and integrative therapies, patient education, and improved access to interdisciplinary chronic pain care. Conclusions Lack of standardized multifaceted tools, time constraints on chronic pain appointments, inadequate provider education, and limited access to complementary and integrative health therapies are significant provider challenges. Insurance coverage for complementary and integrative health therapies needs to be expanded. The Stepped Care Model of Pain Management is a positive and definite stride toward addressing many of these challenges. Future studies should examine the extent of improvement in guidelines-concordant chronic pain care, patient outcomes, and provider satisfaction following the implementation of the Stepped Care Model of Pain Management in military health settings.

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工具、时间、培训和团队——军事初级保健提供者对改善慢性疼痛评估和管理的看法

简介 初级保健提供者处于慢性疼痛管理的前线，许多人报告在处理与慢性疼痛护理相关的复杂问题时感到沮丧、信心不足和不满。鉴于他们的作用的重要性以及在管理这一具有挑战性的人群中所报告的不足和不满，在考虑慢性疼痛管理方法时了解初级保健提供者的观点非常重要。这项定性描述性研究旨在全面总结提供者面临的挑战和建议，以改善军队初级保健环境中的慢性疼痛护理。材料和方法 在一个美国陆军医疗中心对 12 名军事初级保健提供者进行了半结构化访谈。所有访谈均有录音，时长 30 至 60 分钟。使用 ATLAS 9.0 软件分析访谈记录。使用内容分析的一般归纳方法分析叙述。框架方法用于组织代码和紧急类别。所有研究程序均经华盛顿大学机构审查委员会批准。结果 四个类别反映了提供者在改善慢性疼痛护理方面的挑战和建议：(1) 全面疼痛评估和患者教育的工具，(2) 每次慢性疼痛预约的可用时间，(3) 提供者培训和教育，以及 (4)基于团队的慢性疼痛管理方法。提供者建议使用疼痛评估筛查工具和结果登记，每次访问的时间更长，将慢性疼痛护理纳入健康科学课程、全面一致的提供者培训、补充和综合疗法的保险范围、患者教育以及改善跨学科慢性疼痛护理的可及性。结论 缺乏标准化的多方面工具、慢性疼痛预约的时间限制、提供者教育不足以及获得补充和综合健康疗法的机会有限是提供者面临的重大挑战。补充和综合健康疗法的保险范围需要扩大。疼痛管理的阶梯式护理模式是朝着解决其中许多挑战迈出的积极而明确的一步。未来的研究应该检查指南一致的慢性疼痛护理、患者结果、