For a lot of reasons, including the increase in patient numbers and the complexity of pain management, we see a lot more NPs, PAs and advanced practice nurses working as primary practitioners in collaboration with the other physicians on their team. Not only do we see advanced practice providers in the acute care setting working just in surgery, we see them in psychiatry, we see them in oncology, we see them working in the anesthesia pre-op clinics, and being part of the whole peri-operative pain process. And so because we've seen so many of these advanced practice providers in the acute care setting, the need for education has quadrupled. I think that PAINWeek has always been receptive to the needs of advanced practice nurses, as well as PAs, in terms of education about pain and I think we've formalized it this year with the APP track. I think one of the key takeaways is collaborative practice in pain management. We focus mostly on multimodal, interdisciplinary management of patients, and in addressing the behavioral management focus, our mental health colleagues, the pharmacists, the nurse practitioners and the PAs are part of the mix. One unique aspect that nursing brings to the team is that they have that history of patient engagement. Not that other pain providers or other practitioners do not, but I think nurses have been trained from early on to listen to the patient, and to focus on their needs from a global perspective, as opposed to just looking at them unidimensionally.
HCAHPS is an independent survey of patient satisfaction with their care. A big part of that patient satisfaction is looking at their pain management. A strength of it is that it makes us as healthcare providers accountable to engage the patient in terms of their treatment, to listen to the patient and make sure that we are on the same page in terms of what the goals of treatment are. So that's the positive to it. On the negative side, it's really directed practice - it allows the patient to direct the practice to where it's perhaps not best for them to be. One of the things that has been brought out in the literature of late is that sometimes opiates are prescribed as a means to get those good HCAHPS scores. Whether you agree with the HCAHPS or not, I think that the premise is good; the engagement of the patient and making sure that we're paying attention to what their psychological and behavioral and spiritual needs are. The not so good is that in some situations it's guided practice possibly to the detriment of the patient.