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      Anatomy of the Pain Centre waiting list at the Centre hospitalier de l’Université de Montréal (CHUM)

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          Abstract

          Background

          Waiting list management at chronic pain clinics has become a serious problem throughout Canada. We analyzed the waiting list at the Centre hospitalier de l’Université de Montréal (CHUM) Pain Centre.

          Methods

          The present study is an observational, prospective study. We used a specifically designed survey questionnaire. Survey findings were analyzed with descriptive statistical methods.

          Results

          A total of 270 patients were contacted; only 146 were included. Of these, 93 were women and 53 men. The average age was 55.9 years. Fifty-two percent of the patients were referred by a medical specialist; 34% by family physicians; 3% for emergency; and 11% unknown. The mean for pain score was 6.7/10. Seventy-three percent were taking pain killers with an average improvement on their pain score of 52%. Ten percent of respondents were not taking any type of analgesic medication, while 17% were taking over-the-counter drugs. Fifty-three percent of the patients had been suffering from chronic pain for 5 years or less, while 10% had been suffering and awaiting specialized pain treatment for more than 20 years.

          Conclusion

          Our data suggests that accessibility to specialized health care is not the sole obstacle to the timely and effective management of chronic pain. Seventy-three percent of the patients were taking some form of pharmaceutical treatment for pain and reported an average improvement rate of 52% on their pain score under medication. Such inconsistency may be attributable to patients’ lack of compliance with their treatment. The World Health Organization Working Group recommended in chronic patients a novel approach to health care, based on patient therapeutic education. Our results show that patients need to acquire self-management skills regarding their chronic conditions.

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          Most cited references 30

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          Meta-analysis: chronic disease self-management programs for older adults.

          Although enthusiasm is growing for self-management programs for chronic conditions, there are conflicting data regarding their effectiveness and no agreement on their essential components. To assess the effectiveness and essential components of self-management programs for hypertension, osteoarthritis, and diabetes mellitus. The authors searched multiple sources dated through September 2004, including the Cochrane Library, MEDLINE, PsycINFO, and Nursing and Allied Health databases, and bibliographies of 87 previous reviews. Randomized trials that compared outcomes of self-management interventions with a control or with usual care for diabetes mellitus, osteoarthritis, or hypertension; outcomes included hemoglobin A1c level, fasting blood glucose level, weight, blood pressure, pain, or function. Two reviewers independently identified trials and extracted data regarding whether the intervention used tailored adjustments to meet individual patient needs, a group setting, feedback, and psychological services, and whether the intervention was provided by the patient's usual physician. Of 780 studies screened, 53 studies contributed data to the random-effects meta-analysis (26 diabetes studies, 14 osteoarthritis studies, and 13 hypertension studies). Self-management interventions led to a statistically and clinically significant pooled effect size of -0.36 (95% CI, -0.52 to -0.21) for hemoglobin A1c, equivalent to a reduction in hemoglobin A1c level of about 0.81%. Self-management interventions decreased systolic blood pressure by 5 mm Hg (effect size, -0.39 [CI, -0.51 to -0.28]) and decreased diastolic blood pressure by 4.3 mm Hg (effect size, -0.51 [CI, -0.73 to -0.30]). Pooled effects of self-management interventions were statistically significant but clinically trivial for pain and function outcomes for osteoarthritis. No consistent results supported any of the 5 characteristics examined as essential for program success. Studies had variable quality, and possible publication bias was evident. Self-management programs for diabetes mellitus and hypertension probably produce clinically important benefits. The elements of the programs most responsible for benefits cannot be determined from existing data, and this inhibits specification of optimally effective or cost-effective programs. Osteoarthritis self-management programs do not appear to have clinically beneficial effects on pain or function.
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            A systematic review of the effect of waiting for treatment for chronic pain.

            In many countries timely access to care is a growing problem. As medical costs escalate health care resources must be prioritized. In this context there is an increasing need for benchmarks and best practices in wait-time management. The Canadian Pain Society struck a Task Force in December 2005 to identify benchmarks for acceptable wait-times for treatment of chronic pain. As part of the mandate a systematic review of the literature regarding the relationship between waiting times, health status and health outcomes for patients awaiting treatment for chronic pain was undertaken. Twenty-four studies met the inclusion criteria for the review. The current review supports that patients experience a significant deterioration in health related quality of life and psychological well being while waiting for treatment for chronic pain during the 6 months from the time of referral to treatment. It is unknown at what point this deterioration begins as results from the 14 trials involving wait-times of 10 weeks or less yielded mixed results with wait-times amounting to as little as 5 weeks, associated with deterioration. It was concluded that wait-times for chronic pain treatment of 6 months or longer are medically unacceptable. Further study is necessary to determine at what stage the deterioration begins from the onset of pain to treatment and the impact of waiting on treatment outcomes. Most important is the need to improve access to appropriate care for patients with chronic pain, an escalating public health care problem with significant human and economic costs.
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              Inequities In Health Care: A Five-Country Survey

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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2013
                08 July 2013
                : 6
                : 531-537
                Affiliations
                [1 ]Pain Clinic Hôtel-Dieu, Centre Hospitalier de l’Université de Montreal CHUM, Canada
                [2 ]Centre de Recherche du Centre Hospitalier de l’Université de Montreal CRCHUM, Canada
                [3 ]Pain Clinic, Hôpital Sacre-Coeur, Montréal, Québec, Canada
                Author notes
                Correspondence: Grisell Vargas-Schaffer 3840 rue Saint Urbain, Clinique antidouleur Hôtel-Dieu du CHUM, Montreal, Quebec H2W1T8, Canada, Tel +1 514 890 8000, Fax +1 514 412 7132, Email grisell.vargas.chum@ 123456ssss.gouv.qc.ca
                Article
                jpr-6-531
                10.2147/JPR.S46118
                3712996
                23874120
                © 2013 Vargas-Schaffer, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

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                Short Report

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