From (Ontario Ministry of Health and Long-Term Care) policy to implementation: A retrospective look at a community-based patient-centered model of care for chronic pain

Abstract

Background: Chronic pain is one of the most widely recognized, disabling, and expensive health problems in Canada. Interdisciplinary multimodal pain management is effective in helping chronic pain patients lessen symptoms and reclaim functionality, but most patients lack access to such treatments. Aim: The aim of this study was to describe the development and implementation of a publicly funded and patient-centered model of care in the community. Methods: The study was set in the Pain & Wellness Centre (PWC) in Vaughan, the only community-based chronic pain clinic in Ontario funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC) as a demonstration project of a template for similar future community clinics. The study is descriptive, including a brief review of the Ontario comprehensive pain strategy framework and an overview of the PWC and the process involved in the development of an interdisciplinary pain program (IDP), based on the biopsychosocial model of chronic pain management. Results: During a 2.5-year period, the PWC has offered 1055 new patient medical consultations and 1921 follow-up visits and admitted 242 patients in the IDP program (demonstrating significant success in patient outcomes at the 3-month exit from the program). It established robust outcomes research, organized educational programs for pain trainees, and cultivated a collaborative relationship with the Toronto Academic Pain Medicine (TAPMI) network and the community at large. Conclusions: This demonstration program has shown the feasibility and applicability of the principles of the MOHLTC comprehensive pain strategy, providing an effective, evidence-based, and accountable approach to chronic pain diagnosis and management in the community. RÉSUMÉContexte: La douleur chronique est l'un des problèmes de santé les plus reconnus, invalidants et coûteux au Canada. La prise en charge multimodale interdisciplinaire est efficace pour aider les patients souffrant de douleur chronique à diminuer leurs symptômes et à recouvrer leur fonctionnalité, mais la plupart des patients n'ont pas accès à de tels traitements. But: Le but de cette étude était de décrire l'élaboration et la mise oeuvre d'un modèle communautaire de soins axé sur le patient, financé par des fonds publics. Méthodes: L'étude s'est déroulée au Pain and Wellness Centre à Vaughan, la seule clinique de la douleur chronique communautaire en Ontario. Elle était financée par le MSSLD en tant que projet de démonstration pouvant servir de modèle pour des cliniques communautaires semblables dans l'avenir. L'étude est descriptive et comprend notamment un survol du cadre stratégique global pour la douleur de l'Ontario et un aperçu du Pain & Wellness Centre, de même que du processus menant à l'élaboration d'un programme interdisciplinaire de la douleur fondé sur le modèle bio-psycho-social de la prise en charge de la douleur chronique. Résultats: Au cours d'une période de 2,5 ans, le PWC a offert des consultations médicales à 1055 nouveaux patients et 1921 visites de suivi, en plus...

Long term outcomes of chronic pain patients attending a publicly funded community-based interdisciplinary pain program in the Greater Toronto area: results of a practice-based audit

“…The study was approved for retrospective analysis by the University of Toronto Research Ethics Board (Protocol Approval #36903). Patients were derived from the general population of patients seen in PWC and met the following criteria published in a previous study [ 6 ]: Distance of no more than 50 km (30 Mi) from the clinic (in order to be able to drive or commute frequently, particularly in inclement weather) though exceptions are granted on an individual basis; good command of verbal/written English; no major untreated or poorly treated psychopathology (morbid depression, significant suicidal ideation, disabling anxiety) or life crisis (such as acrimonious divorce, custody battle etc. ); high levels of motivation and commitment as judged by the interaction with consulting MD and staff; and availability to attend the clinic 3 times a week for a minimum of 2 h per session for 3–4 months.…”

“…Schatman [ 5 ], summarized the literature illustrating that interdisciplinary pain programs have a stronger evidence base for efficacy, cost effectiveness, and lack of iatrogenic complications. However, lack of funding is one of the most significant barriers in accessing interdisciplinary pain management programs [ 3 , 6 ].…”

“…In Ontario (the largest province of Canada), the Ministry of Health and Long Term Care (MOHLTC) created in 2011 a Chronic Pain Working Group which produced a White (policy) Paper, pointing to a long number of problems in the province and outlined the essential elements needed to support a comprehensive pain system. Details of the process have been published elsewhere [ 6 ].…”

“…The latter provides medical and pharmacological management as needed, combination of allied health services (psychology, mindfulness, nutritional and dietary counselling, massage therapy including lymphatic drainage, manual and exercise therapy) and access to a community resource facilitator (community navigator). Details about the PWC and the IDP program have been published elsewhere [ 6 ].…”

Demographics, Pain Characteristics and Diagnostic Classification Profile of Chronic Non-Cancer Pain Patients Attending a Canadian University-Affiliated Community Pain Clinic

“…GTA encompasses an area of 7124 km 2 with a population of 5.93 million. A detailed description of the PWC model of care was recently published [ 13 ]. The secondary aim is to compare our findings to those of existing studies from Canadian pain clinics to determine similarities and differences among the populations.…”