Advanced clinical prioritisation in an Irish, tertiary, chronic pain management service: an audit of outcomes

Abstract

Background Advanced clinical prioritisation (ACP) pathways could potentially improve the interface between primary and secondary care, instigating appropriate treatment pathways with improved efficiencies. Telemedicine is a key component of ACP pathways. Aims Telephone consultations for new referrals (as part of a pilot ACP pathway for chronic pain) were trialled to try (a) improve efficiency of outpatient clinics, (b) expedite assessment/treatment, and (c) reduce the number of face-to-face attendances. An audit of this activity was undertaken. Methods The 100 longest waiting new referrals were identified. Over a 9-month period patients were contacted via telephone, undergoing an initial assessment. Treatment plans were initiated and outcomes (≥ 1) were documented. Results Average length of time on waiting list was 35.37 months. 40% patients were discharged with advice back to referrer, 8% were referred for diagnostics/imaging, 32% were offered pharmacological management, 30% were scheduled for interventional management, 9% were referred for further MDT assessment/treatment, 4% were referred directly for a pain management programme (PMP), 6% were referred for assessment by other specialist services, 9% were brought in for face-toface consultation in our pain management OPD, 2% were uncontactable, and 1% had died before assessment could be made. Conclusions Telemedicine as part of ACP represents an opportunity to improve speed of access to care, reducing the number of patients and time spent on waiting lists. Future studies should be directed at assessing efficacy of treatment plans initiated in telemedicine clinics whilst also looking at cost effectiveness and patient satisfaction.