Lise Dassieu1,2, Manon Choinière3,4, Laurence Saint-Jean3,5, Fiona Webster6, Philip Peng7,8, Norm Buckley9,10, Ian Gilron11,12, Owen Williamson13,14, G Allen Finley15,16, Krista Baerg17,18, Audrée Janelle-Montcalm3, Maria Hudspith19, Aline Boulanger4,20, Tania Di Renna7,21, Howard Intrater22,23, Brenda Lau24,25, John Pereira26,27. 1. Research Center of the Centre Hospitalier de l'Université de Montréal, Saint Antoine Building, 850 Saint Denis Street, Montreal, QC, H2X 0A9, Canada. lise.dassieu@umontreal.ca. 2. Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. lise.dassieu@umontreal.ca. 3. Research Center of the Centre Hospitalier de l'Université de Montréal, Saint Antoine Building, 850 Saint Denis Street, Montreal, QC, H2X 0A9, Canada. 4. Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. 5. Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. 6. Arthur Labatt Family School of Nursing, Western University, London, ON, Canada. 7. Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 8. Department of Anesthesiology, University Health Network-Western Hospital, Toronto, ON, Canada. 9. Department of Anesthesia, Michael G DeGroote School of Medicine, Hamilton, ON, Canada. 10. Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada. 11. Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada. 12. Department of Anesthesiology, Kingston General Hospital, Kingston, ON, Canada. 13. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 14. JPOCSC Pain Management Clinic, Fraser Health Authority, Surrey, BC, Canada. 15. Department of Anesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. 16. Center for Pediatric Pain Research, IWK Health, Halifax, NS, Canada. 17. Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada. 18. Department of Pediatrics, Saskatchewan Health Authority, Saskatoon, SK, Canada. 19. Pain BC Society, Vancouver, BC, Canada. 20. Pain Clinic, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. 21. Department of Anesthesiology, Women's College Hospital, Toronto, ON, Canada. 22. Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 23. Pain Clinic, Health Sciences Centre, Winnipeg, MB, Canada. 24. Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada. 25. CHANGE Pain Clinic, Vancouver, BC, Canada. 26. Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 27. Calgary Chronic Pain Center, Alberta Health Services, Edmonton, AB, Canada.
Abstract
PURPOSE: A multidisciplinary approach is recommended for patients with complex chronic pain (CP). Many multidisciplinary pain treatment facilities (MTPFs) use patient exclusion criteria but little is known about their characteristics. The objective of this study was to describe the frequency and characteristics of exclusion criteria in public Canadian MTPFs. METHODS: We conducted a cross-sectional study in which we defined an MPTF as a clinic staffed with professionals from three disciplines or more (including at least one medical specialty) and whose services were integrated within the facility. We disseminated a web-based questionnaire in 2017-2018 to the administrative leads of MPTFs across the country. They were invited to complete the questionnaire about the characteristics of their facilities. Data were analyzed using descriptive statistics and correlation measures. RESULTS: A total of 87 MTPFs were included in the analyses. Half of them (52%) reported using three exclusion criteria or more. There was no significant association between the number of exclusion criteria and wait time for a first appointment or number of new consultations in the past year. Fibromyalgia and migraine were the most frequently excluded pain syndromes (10% and 7% of MPTFs, respectively). More than one MPTF out of four excluded patients with mental health disorders (30%) and/or substance use disorders (29%), including MPTFs with specialists in their staff. CONCLUSIONS: Multidisciplinary pain treatment facility exclusion criteria are most likely to affect CP patients living with complex pain issues and psychosocial vulnerabilities. Policy efforts are needed to support Canadian MPTFs in contributing to equitable access to pain management.
PURPOSE: A multidisciplinary approach is recommended for patients with complex chronic pain (CP). Many multidisciplinary pain treatment facilities (MTPFs) use patient exclusion criteria but little is known about their characteristics. The objective of this study was to describe the frequency and characteristics of exclusion criteria in public Canadian MTPFs. METHODS: We conducted a cross-sectional study in which we defined an MPTF as a clinic staffed with professionals from three disciplines or more (including at least one medical specialty) and whose services were integrated within the facility. We disseminated a web-based questionnaire in 2017-2018 to the administrative leads of MPTFs across the country. They were invited to complete the questionnaire about the characteristics of their facilities. Data were analyzed using descriptive statistics and correlation measures. RESULTS: A total of 87 MTPFs were included in the analyses. Half of them (52%) reported using three exclusion criteria or more. There was no significant association between the number of exclusion criteria and wait time for a first appointment or number of new consultations in the past year. Fibromyalgia and migraine were the most frequently excluded pain syndromes (10% and 7% of MPTFs, respectively). More than one MPTF out of four excluded patients with mental health disorders (30%) and/or substance use disorders (29%), including MPTFs with specialists in their staff. CONCLUSIONS: Multidisciplinary pain treatment facility exclusion criteria are most likely to affect CP patients living with complex pain issues and psychosocial vulnerabilities. Policy efforts are needed to support Canadian MPTFs in contributing to equitable access to pain management.
Authors: A Carbonell-Baeza; V A Aparicio; P Chillón; P Femia; M Delgado-Fernandez; J R Ruiz Journal: Clin Exp Rheumatol Date: 2012-01-03 Impact factor: 4.473
Authors: Bruce Wallace; Colleen Varcoe; Cindy Holmes; Mehmoona Moosa-Mitha; Gregg Moor; Maria Hudspith; Kenneth D Craig Journal: Int J Equity Health Date: 2021-02-02