Table 2 Additional quality indicators for chronic pain management in community-dwelling older adults identified through semi-structured interviews

Pain relief effects (additional secondary indicator)

Treatment rate of moderate to severe pain (additional tertiary indicator)

“The quality of chronic pain management in community-dwelling older adults hinges on effective assessment and continuous improvement of all aspects of care. This quality is typically evaluated across three dimensions: structure, process, and outcome, with outcome quality serving as the most direct measure of effectiveness. Within outcome quality, the focus is on pain relief effects and analgesic assessment. Pain relief effectiveness is assessed by indicators such as the treatment rate of moderate-to-severe pain and the proportion of elderly patients showing control of chronic pain. The treatment rate for moderate-to-severe pain measures success in managing severe pain, which is particularly challenging in older adults due to the complexity of their conditions. The chronic pain control rate reflects the overall effectiveness of pain management, indicating how many patients experience effective pain relief. Analgesic assessment is primarily measured by the analgesic adequacy rate, which reflects the percentage of patients who perceive their pain as adequately relieved. This indicator captures both the medical effectiveness of treatment and patient satisfaction. A high adequacy rate suggests that pain management has achieved its goals.”

Proportion of elderly patients showing control of chronic pain (additional tertiary indicator)

Analgesic assessment

Analgesic adequacy rate (additional tertiary indicator)

Pharmacological intervention for pain

Prophylactic use of analgesics for patients with chronic pain (additional tertiary indicator)

“Our community health center has implemented various strategies to manage chronic pain in older adults, with a focus on process quality improvement. One of the core strategies we utilize is pharmacologic intervention. We primarily intervene through individualized analgesic medication management. For elderly patients with chronic pain, we develop a personalized medication regimen based on their pain level, physical condition, and other comorbidities. This approach includes not only conventional pain medications but also involves the prophylactic use of analgesics for patients with chronic pain.”

System

Guidelines for managing chronic pain in older adults (additional tertiary indicator)

“There remains significant room for improvement in the management of chronic pain in elderly patients at community health centers. A critical area for enhancement is the establishment of a comprehensive management system, particularly from the perspective of structural quality. Currently, pain management systems in many community health centers are insufficient, with a notable deficiency being the absence of guidelines specifically tailored to chronic pain management in the elderly.These centers often rely on general medical guidelines for pain management, which do not adequately address the unique needs of elderly patients. Given that elderly patients have distinct physiological characteristics, comorbidities, and medication responses compared to the general adult population, there is a pressing need for dedicated guidelines to effectively guide the management of chronic pain in this demographic.”