Abstract
Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors' pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed. All referrals to the Queen Elizabeth II Health Sciences Centre's Pain Management Unit for a one-year period were reviewed and triaged as either 'regular waiting list' or 'fast track'. Patients in the fast track group were seen within four months and required limited interventions or were urgent in nature. The regular waiting list group waited up to 27 months for assessment and development of a treatment plan. Treatment recommendations were faxed to the referring physician. A follow-up questionnaire was sent to each physician to assess whether these treatment recommendations were useful. Recommendations were faxed for 297 patients. One hundred forty-nine physicians returned the follow-up questionnaire. Ninety-five physicians used the recommendations and 68 patients followed the recommendations. Seventy-nine physicians felt that the recommendations were helpful to them in their care of the patient. For 39 patients, the recommendations were helpful. The most frequently used recommendations were those on medications (eg, tricylic antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drugs and controlled-release opioids). Other modalities included participation in an interdisciplinary group program and physiotherapy. A triage review process with recommendations faxed to referring physicians was developed and put into action for one year. The recommendations were used by 32% of the physicians (64% of responding physicians). Fifty-three per cent of responding physicians felt that the recommendations were helpful in the care of their patient. This process led to a benefit in care, as perceived by the physician, in 26% of patients (of physicians who returned the questionnaire [13% of all patients]) on the waiting list for a tertiary care pain management unit.
Highlights
MethodsFrom December 1, 2002 to November 30, 2003, all referrals to the Pain Management Unit at Queen Elizabeth II Health Sciences Centre (QEIIHSC) were triaged by one of two authors (AJC, IB) to two triage paths: fast track or regular waiting list
To properly manage our waiting list, we initially developed a triage process whereby patients were categorized into three groups
It was felt that some pain management techniques could be used by primary care physicians for their patients if the physician was provided with recommendations by specialists who care for patients with chronic pain
Summary
From December 1, 2002 to November 30, 2003, all referrals to the Pain Management Unit at QEIIHSC were triaged by one of two authors (AJC, IB) to two triage paths: fast track or regular waiting list. Each patient on the regular waiting list was asked to complete a Pain Evaluation Questionnaire. The information from the referring physician and the Pain Evaluation Questionnaire was reviewed by one of two authors (AJC, IB). Recommendations about possible care were entered on a form (Appendix 1) that was faxed to the referring physician so that these recommendations might be used while the patient was waiting for an assessment. Three months after these recommendations were sent by fax, a second form (Appendix 2) was sent to the physician to obtain feedback about whether the recommendations had been used in the care of their patient, whether the recommendations had been useful in this care and whether the physician thought this process was helpful in the management of the patient
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