First Steps Toward Understanding the Variability in Acute Pain Service Provision and the Quality of Pain Relief in Everyday Practice Across the United Kingdom (original) (raw)
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A survey of acute pain services in the UK
Anaesthesia, 2017
The organisational state of inpatient pain management in UK hospitals is difficult to determine. We sent an electronic questionnaire to 209 acute pain service leads throughout the UK. Questions were about staffing and service provision. We received 141 responses (67%); 47% of all UK hospitals. Each service was responsible for a median (IQR [range]) of 566 (400-839 [120-2800]) beds. Each acute pain specialist nurse was responsible for 299 (238-534 [70-1923]) beds. The mean (SD) number of consultant hours per week was 5.54 (4.62), delivered by a median of 1.0 (1.0-2.5 [0.2-7.0]) consultant. Overnight cover was provided by 20 (15%) acute pain services, and weekend cover by 39 (29%). Acute pain services commonly (in 50 (35%) hospitals) had roles in addition to acute pain management. Most teams (105, (77%)) reviewed medical patients and patients with chronic pain (in 131, (96%) teams). Half of the services (56, (49%)), reported that they were part of an integrated acute and chronic pain service, however, 83 (59%) did not have any members who work in chronic pain clinics. The majority (79, (70%)) were able to access a nominated chronic pain consultant for advice. Provision of acute pain services throughout the UK is highly variable. The majority do not meet core UK standards.
The National Pain Audit for specialist pain services in England and Wales 2010–2014
British Journal of Pain
Introduction: Numerous reports highlight variations in pain clinic provision between services, particularly in the provision of multidisciplinary services and length of waiting times. A National Audit aims to identify and quantify these variations, to facilitate raising standards of care in identified areas of need. This article describes a Quality Improvement Programme cycle covering England and Wales that used such an approach to remedy the paucity of data on the current state of UK pain clinics. Methods: Clinics were audited over a 4-year period using standards developed by the Faculty of Pain Medicine of The Royal College of Anaesthetists. Reporting was according to guidance from a recent systematic review of national surveys of pain clinics. A range of quality improvement measures was introduced via a series of roadshows led by the British Pain Society. Results: 94% of clinics responded to the first audit and 83% responded to the second. Per annum, 0.4% of the total national po...
Journal of Evaluation in Clinical Practice, 2014
Rationale, aims and objectives Management of post-operative pain is unsatisfactory worldwide. An estimated 240 million patients undergo surgery each year. Forty to 60% of these patients report clinically significant pain. Discrepancy exists between availability of evidence-based medicine (EBM)-derived knowledge about management of perioperative pain and increased implementation of related practices versus lack of improvement in patient-reported outcomes (PROs). We aimed to assist health care providers to optimize perioperative pain management by developing and validating a medical registry that measures variability in care, identifies best pain management practices and assists clinicians in decision making. Methods PAIN OUT was established from 2009 to 2012 with funding from the European Commission. It now continues as a self-sustaining, not-for-profit project, targeting health care professionals caring for patients undergoing surgery. Results The growing registry includes data from 40 898 patients, 60 hospitals and 17 countries. Collaborators upload data (demographics, clinical, PROs) from patients undergoing surgery in their hospital/ward into an Internet-based portal. Two modules make use of the data: (1) online, immediate feedback and benchmarking compares PROs across sites while offline analysis permits in-depth analysis; and (2) the case-based clinical decision bs_bs_banner
Journal of Pain Research, 2015
Background: Chronic pain clinics aim to improve challenging conditions, and although numerous studies have evaluated specific aspects of therapies and outcomes in this context, data concerning service impact on outcome measures in a general pain population are sparse. In addition, current trends in commissioning increasingly warrant services to provide evidence for their effectiveness. While a plethora of outcome measures, such as pain-intensity or improvement scores, exist for this purpose, it remains surprisingly unclear which one to use. It also remains uncertain what variables predict treatment success. Objectives: This cross-sectional study was conducted to evaluate clinic performance employing different tools (pain scores, pain categories, responder analysis, subjective improvement, satisfaction), and to determine predictors of outcome measures. Patients and methods: Patients attending scheduled clinic follow-up appointments were approached. They were asked to complete the modified short-form Brief Pain Inventory (BPI-SF) that also included assessments for satisfaction and subjective improvement. Comparisons were made with BPI-SF responses that were completed by each patient on admission. Nonparametric tests were employed to evaluate service impact and to determine predictors for outcome. Results: Data of 118 patients were analyzed. There was considerable variation in impact of pain clinics depending on the outcome measure employed. While median pain scores did not differ between admission and follow-up, scores improved individually in 30% of cases, such that more patients had mild pain on follow-up than on admission (relative risk 2.7). Furthermore, while only 41% reported at least moderate subjective improvement after admission to the service, the majority (83%) were satisfied with the service. Positive treatment responses were predicted by "number of painful regions" and "changes in mood", whereas subjective improvement was predicted by "helpfulness of treatments". Conclusion: Depending on the outcome measure employed, pain clinics showed varying degrees of impact on patients' pain experiences. This calls into question the current practice of using nonstandardized outcome reporting for evaluation of service performances.
Pain Management in Hospitals: Assessment and Evaluation
SOAOJ International Publications, 2019
Objectives Despite the increased focus on pain management, suboptimal pain control has been frequently documented to negatively impact patients' health. This study evaluates pain management practice and its impact on daily activities. Methods A prospective cross-sectional study was conducted in two hospitals from April to July 2017. A face-to-face questionnaire was filled out regarding pain scores, and appropriateness of therapy as the main outcome measure. Medical and surgical adult patients with all pain types were eligible to participate. Data on medication regimens and combinations were collected from medical records. The association between categorical variables was evaluated using Pearson x 2 or Fisher's exact tests and continuous variables using student (independent) T-test. An alpha of <0.05 was considered significant. Results Results from 183 participants with a mean age of 49 (SD=17.33) revealed that pain was their main reason for hospitalization in 71.4% of the cases. Inappropriate therapy was detected in 70.5% of the cases regardless of pain severity. We noted also that only 24.6% had complete follow-up during the first 48 hours. Unfavorable practices included lack of pain assessment prior to drug administration (41.5%) and lack of pain score documentation (54.6%). Adequacy of therapy was also dependent on insurance health coverage (p=0.009). Conclusion Pain remains a prevalent problem that requires efforts for improvement. Our study highlights the need for implementing international recommendations to minimize risk and optimize pain management.
BMJ Open, 2018
Objectives: Our central research question was, in England, are geographical inequalities in opioid use driven by health need (pain)? To answer this question, our study examined: (1) if there are regional inequalities in rates of chronic pain prevalence, pain intensity and opioid utilisation in England; (2) if opioid use and chronic pain are associated after adjusting for individual-level and area-level confounders. Design Cross-sectional study design using data from the Health Survey for England 2011. Setting: England. Primary and secondary outcome measures: Chronic pain prevalence, pain intensity and opioid utilisation. Participants: Participant data relating to chronic pain prevalence, pain intensity and opioid usage data were obtained at local authority level from the Health Survey for England 2011; in total, 5711 respondents were included in our analysis. Methods: Regional and local authority data were mapped, and a generalised linear model was then used to explore the relationships between the data. The model was adjusted to account for area-level and individual-level variables. Results: There were geographical variations in chronic pain prevalence, pain intensity and opioid utilisation across the English regions—with evidence of a ‘pain divide’ between the North and the South, whereby people in the North of England more likely to have ‘severely limiting’ or ‘moderately limiting’ chronic pain. The intensity of chronic pain was significantly and positively associated with the use of opioid analgesics. Conclusions: There are geographical differences in chronic pain prevalence, pain intensity and opioid utilisation across England—with evidence of a ‘pain divide’. Given the public health concerns associated with the long-term use of opioid analgesics—and their questionable activity in the management of chronic pain—more guidance is needed to support prescribers in the management of chronic pain, so the initiation of opioids can be avoided.
Pain management in hospitals: patients’ satisfaction and related barriers
Pharmacy Practice, 2018
Background: Suboptimal pain control has been frequently reported in healthcare settings and documented to negatively impact patients' health. Patients' perception regarding pain management may influence their satisfaction regarding treatment. Objectives: This study focuses on the assessment of patients' satisfaction regarding pain therapy and defining patient-related barriers for its implication. Methods: A cross-sectional study was conducted in two tertiary care hospitals from April till July 2017. A face-to face interview questionnaire was filled regarding pain scores and patients' attitudes regarding pain management. Both medical and post-surgical adult patients with all types of pain were eligible to participate. A descriptive analysis of patient satisfaction and perceptions regarding pain management was done. Results: Results from 183 participants with a mean age of 49 (SD=17.33) revealed that pain was their main reason for hospitalization (71.6% of the cases). Numeric pain scores were recorded only in 14.2% of the patient medical files. Pain intensity documentation by healthcare professionals was found in 41.5% of the cases, and 7.7% of the patients had to wait for more than 30 minutes before getting the pain medication. Around 85% of the patients were satisfied with their pain management. Patients' barriers to effective pain therapy were mainly fear of adverse effects, addiction, and additional costs (p<0.05). Conclusions: Pain remains a prevalent problem that requires more efforts for improvement. Our study can effectively serve as a start for larger studies where barriers to pain management can be assessed as an independent variable affecting pain management practice.
Pain Assessment in Specialist Services for Older People-A National Perspective
Journal of the American Geriatrics Society, 2010
Background Numerous reports highlight variations in pain clinic provision between services, particularly in the provision of multidisciplinary services and length of waiting times. A national audit aims to identify and quantify these variations, to facilitate raising standards of care in identified areas of need. This paper describes a quality improvement programme cycle covering England and Wales that used such an approach to remedy the paucity of data on the current state of UK pain clinics. Methods Clinics were audited over a four year period using standards developed by the Faculty of Pain Medicine of The Royal College of Anaesthetists. Reporting was according to guidance from a recent systematic review of national surveys of pain clinics. A range of quality improvement measures was introduced via a series of roadshows led by the British Pain Society. Results Ninety-four percent of clinics responded to the first audit and 83% responded to the second. Per annum, 0.4% of the total national population was estimated to attend a specialist pain service. A significant improvement in multidisciplinary staffing was found (35% to 56%, p<0.001) over the four year audit programme, although this still requires improvement. Very few clinics achieved recommended evidence-based waiting times, although only 2.5% fell outside government targets; this did not improve. Safety standards were generally met. Clinicians often failed to code diagnoses. Conclusions A National Audit found that whilst generally safe many specialist pain services in England and Wales fell below recommended standards of care. Waiting times and staffing require improvement if patients are to get effective and timely care. Diagnostic coding also requires improvement.
Pain Management Nursing, 2014
Pain management is an important aspect of providing quality health care, and monitoring patient-related outcomes is a recommended quality improvement practice. Valid and reliable tools are needed for this purpose. The American Pain Society Patient Outcome Questionnaire (APS-POQ) is widely used to measure quality of pain management. The APS-POQ was recently revised to reflect advances in pain management. The purpose of this study was to test the psychometric properties of the revised version in Icelandic patients in the hospital setting. The questionnaire was translated according to an adaptation of Brislin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s model. Data were collected from 143 patients on 23 wards in a university hospital. Participants were ≥ 18 years old, hospitalized for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;24 hours, alert, not too ill to participate, and in pain ≥ 1 on a 0-10 scale in the past 24 hours. Mean (SD) age was 66 (18) years, 51.4% were women, 48.6% men. Principal component analysis with varimax rotation confirmed a five-component structure, but four items lowered reliability and were removed from the scales. The final version consists of four components, with Cronbach α &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.70, explaining 64.2% of the variance. Participants had little difficulty in answering the questionnaire, but two additional items about participation in decisions and pain medications were added in response to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; comments and suggestions. Administering the Icelandic version of the APS-POQ-R was found to be feasible, and the questionnaire has acceptable construct validity and reliability. The results support the use of the APS-POQ-R-I to evaluate the quality of pain management in hospitals in Iceland.