Evaluating care of patients reporting pain in fundholding practices (original) (raw)
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Scandinavian Journal of Primary Health Care, 1999
low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From Objecti7e-To study the relations between population prevalence of 1987 to 1996 we found an increasing number of individuals seeking chronic pain and pain-related diagnoses (musculoskeletal and primary care with pain-related diagnoses. The increase was mainly headaches) in primary health care (PHC) and to examine longitudiassigned to the groups of fibrositis/myalgia and headache. nal variations in these diagnoses. Conclusion-Pain-related diagnoses in PHC reflect partly the occur-Design-A population-based mailed survey to catch prevalence data rence of self-reported chronic pain symptoms in the population. The and continuous computerised diagnosis registration in PHC. observed increase in visits with pain-related diagnoses in the last 10 Setting-General population in a well-defined Swedish PHC district. years is due to an increased number of individuals with soft-tissue Subjects-A random sample of 15% of the population aged 25-74, rheumatism and headaches. Future studies will have to elucidate n= 1101. Annual visitors to district physicians at the health centre. whether these findings are due to an increase in morbidity or changes Main outcome measures-Rates of pain-related diagnoses in PHC in care-seeking and social conditions. in relation to population prevalence of chronic pain. Comparisons of Key words: chronic pain, primary health care, visits, musculoskeletal the number of individuals (annual visiting rates) with pain-related pain, headache. diagnoses 1987-1996. Results-Population pain prevalence and pain-related diagnoses in H. Ingemar Andersson, MD, Bromölla Health Centre, SE-295 35 PHC corresponded as regards the magnitude and distribution of Bromölla, Sweden. chronic pain by age and partly by pain location. Compared to
Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain
Scandinavian Journal of Pain, 2017
Background and aims Pain is one of the most common reasons for patients to seek primary health care. Pain relief is likely to be achieved for patients suffering from acute pain, but for individuals with chronic pain it is more likely that the condition will persist. These patients have the option of being referred to specialised pain clinics. However, the complexity surrounding chronic pain patients is not well studied in these settings. This study aimed to describe patients with chronic pain referred to a pain clinic by using the information submitted during their first visit and one year later and also to identify associations between baseline characteristics and improvements in health-related quality of life in the follow-up. Methods This was a longitudinal observational study of a sample consisting of 318 patients referred to a pain clinic. One group of patients containing 271 individuals (median age 48, 64% females) was assessed and received conventional pain treatment (CPT gro...
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...
British Journal of Pain, 2018
Introduction: The present study audited the process of assessing and selecting patients for a pain management programme with the aim of reviewing best practice in the light of the latest British Pain Society guidelines for pain management programmes for adults. The guidelines include defined inclusion/exclusion criteria and it was explored how they are used by clinicians providing a pain management service. Method: The records of 200 consecutive patients who attended a multidisciplinary assessment for a central London specialist Pain Management Service from September 2014 to December 2014 were audited. The proportions of patients who were offered a programme, were discharged or referred for a different service were calculated. Clinic letters were reviewed to collect information on assessment outcomes, recommendations and inclusion/exclusion criteria used. Results: About half the patients (53%) seen for assessment were offered treatment within the service, most frequently the intensi...
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.
Acta clinica Croatica, 2013
Evaluation of healthcare services by patients is an essential component of quality improvement. We studied association between patient satisfaction and accessibility of healthcare services to patients with chronic nonmalignant pain. A hundred patients from the Pain Clinic, Split University Hospital Center, Split, Croatia, completed a 27-item questionnaire about their condition, duration of chronic pain treatment, access to healthcare, waiting times for various healthcare services, and their satisfaction with the pain clinic and health system. Patients were referred to the pain clinic after median of 4.5 years of chronic nonmalignant pain duration. Median waiting time for pain clinic appointment, seeing a specialist and performing diagnostic procedures was 10, 30 and 90 days, respectively. However, some patients waited for an appointment to a specialist and diagnosis for up to one year. Negative association was found between waiting time for pain clinic appointment and healthcare sys...
Pain medicine (Malden, Mass.), 2014
BackgroundPain management for patients in hospital is a major problem. There is significant variation in care provision. Evidence is needed about the ways in which acute pain services are organized in order to understand whether these are linked to important differences in patient outcomes. The National Inpatient Pain Study group is a voluntary collaborative venture of inpatient pain specialists in the United Kingdom who are working toward establishing a national prospective database of service provision and activity.Pain management for patients in hospital is a major problem. There is significant variation in care provision. Evidence is needed about the ways in which acute pain services are organized in order to understand whether these are linked to important differences in patient outcomes. The National Inpatient Pain Study group is a voluntary collaborative venture of inpatient pain specialists in the United Kingdom who are working toward establishing a national prospective database of service provision and activity.ObjectivesThe objectives of this article are 1) to describe current pain service provision and activity 2) to define and monitor the quality and side effects of the primary analgesic techniques, such as central neuraxial block or systemic analgesia, and identify variations in practice.The objectives of this article are 1) to describe current pain service provision and activity 2) to define and monitor the quality and side effects of the primary analgesic techniques, such as central neuraxial block or systemic analgesia, and identify variations in practice.MethodsPhase 1: Surveys were conducted in two phases during 2010–2011. Information about the organization of services was collected from 121 centers via a live Website. Phase 2: The pilot clinical dataset was collected from 13 hospitals in 2011.Phase 1: Surveys were conducted in two phases during 2010–2011. Information about the organization of services was collected from 121 centers via a live Website. Phase 2: The pilot clinical dataset was collected from 13 hospitals in 2011.ResultsResults indicated that staffing varied widely from one to nine nurses per hospital site. Twelve percent of hospitals did not routinely collect data. The main workload was orthopedic and general surgery based on data from 13 hospitals and 29,080 patients in 2011. Thirty-seven percent of patients reported a pain score of moderate to severe pain on the first assessment by the specialist pain team, and 21% reported severe pain. Nausea and vomiting was the most frequent adverse event reported. Sixty-nine major adverse events were logged, of which 64 documented respiratory depression (N = 29,080, 0.22%).Results indicated that staffing varied widely from one to nine nurses per hospital site. Twelve percent of hospitals did not routinely collect data. The main workload was orthopedic and general surgery based on data from 13 hospitals and 29,080 patients in 2011. Thirty-seven percent of patients reported a pain score of moderate to severe pain on the first assessment by the specialist pain team, and 21% reported severe pain. Nausea and vomiting was the most frequent adverse event reported. Sixty-nine major adverse events were logged, of which 64 documented respiratory depression (N = 29,080, 0.22%).ConclusionsProspective longitudinal data has the potential to improve our understanding of variation in process and outcome measures and establish future research priorities.Prospective longitudinal data has the potential to improve our understanding of variation in process and outcome measures and establish future research priorities.
Annals of The Rheumatic Diseases, 2000
Objective-To investigate factors associated with visiting a general practitioner (GP) for non-inflammatory musculoskeletal pain, and to examine whether these factors were aVected by duration (chronic v non-chronic) or location (widespread v regional) of pain. Methods-From a cross sectional postal survey of 20 000 (response rate 59%) randomly selected adults in two counties of Norway, 6408 subjects who had experienced musculoskeletal pain during the past month were included. Patients who reported inflammatory rheumatic diagnoses made by a doctor were excluded. Results-2909 (45%) had consulted a GP for their musculoskeletal pain during the past 12 months. The odds of consulting were significantly increased by being a woman, by having a higher age and lower education, and by being a pensioner or on sick leave. Patients with widespread pain were more likely to consult than those with regional pain, as were patients with chronic compared with non-chronic pain. Greater than median pain intensity was the factor most prominently associated with consultation for men (odds ratio (OR)=2.4; 95% confidence interval (95% CI) 2.0 to 2.9) and for women (OR=2.6; 95% CI 2.3 to 2.9). Overall, consultation was significantly associated with mental distress for women but not for men. Subgroup analyses showed that consultation for chronic pain was significantly associated with greater than median mental distress for both women (OR=1.3; 95% CI 1.1 to 1.6) and men (OR=1.2; 95% CI 1.0 to 1.4), whereas consultation for non-chronic pain was not.