Authors' objectives:

This report addresses the following questions: 1) Is there any information from jurisdictions in or outside Canada on how health-care services for persons with chronic pain are organized, delivered and monitored, particularly if accompanied by data showing outcomes for patients?

2) Is there any research evidence that examines organizational aspects of chronic pain management (e.g., who should provide care and when, multimodal versus unimodal treatment strategies, training for care providers, use of case managers) and shows impact on outcomes such as patient health status (e.g., pain, physical or psychological functioning, quality of life), satisfaction with services, or care-related factors (e.g., waiting times, use of health services, efficiency of referral)?

Authors' recommendations: Based on the material presented in this report, we make the following conclusions: Due to its magnitude as a health problem in the general population, its associated burden, and the viability of modes of intervention, chronic pain (CP) should be considered a priority within healthcare systems. This conclusion applies equally to Quebec. Appropriate resources are required to support the structures and processes involved in providing evidence-based management of CP and monitoring outcomes. A hierarchy of services is required to ensure that the right patients are treated by the right health professional, at the right time. This structure facilitates the process of stepped care, in which patients progressively receive more complex, specialized and, often, costly interventions according to need and in a coordinated manner. Primary care structures and services need to provide timely diagnosis and treatment of CP, where possible (for example, via medications, rehabilitative and physical medicine, behavioural medicine, as needed). Specialized services and multidisciplinary pain clinics (MPCs) are intended to serve more complex cases that persist despite previous treatments. Among more specialized structures such as MPCs it is possible to have a gradation of services, the most comprehensive type involving research and training activities in addition to patient care. An interdisciplinary approach - in which health professionals from different disciplines work together to provide care, as needed for the individual case - is crucial for management of CP at all levels of the healthcare system. This includes links between primary care physicians and physical medicine/rehabilitation practitioners, as well as collaboration between multiple care providers in specialized clinics. Canadian clinical practice guidelines support the interdisciplinary model for management of CP patients. Services need to be integrated and coordinated so that different types of health professionals (from various disciplines and levels of care) can be involved in seamless delivery of care. Care pathways and discharge protocols need to be employed to ensure continuity of care. Education for physicians and allied health professionals at all levels of the health-care system is essential to optimize treatment of patients with CP. CP patients need to be viewed as part of the solution in that they require education about pain, including self-management strategies. CP patient outcomes need to be assessed systematically to ensure quality of care. Employment of information technology and the Internet are vital for the success of any program aimed at restructuring services for patients with CP. High-quality research is essential to guide management of patients with CP. For example, there is a need for data on patient outcomes associated with and costeffectiveness of MPCs in Quebec. The following recommendations take into consideration our review of the evidence and experiences with management of CP in other jurisdictions, combined with an analysis of their implications for Quebec. AETMIS recommends that: Quebec policy-makers at the governmental level, health-care managers, physicians and other health-care professionals, as well as directors of university training programs in health fields, recognize the importance of CP as a major chronic health problem, and that resources be allocated accordingly and progressively by those with the authority to do so. The organization and provision of services for CP patients in Quebec be developed and supported according to a hierarchical and integrated model, which incorporates the principles of stepped care. The organization and delivery of CP services in Quebec be based on an interdisciplinary approach at all levels of care. Strategies be developed and supported to educate physicians as well as allied health professionals about assessment, diagnosis, treatment, rehabilitation, and management of CP, and to facilitate evidence-based practice (using clinical practice guidelines, for example). Monitoring activities of CP services and other quality assurance mechanisms be put into place, notably with regard to patient outcomes and implementation of programs. Funding agencies strongly consider supporting research on patient outcomes, program implementation and process evaluation in CP.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.aetmis.gouv.qc.ca/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé

Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)