Implementation of the Ottawa Hospital Pain Clinic stepped care program: A preliminary report

Abstract

Background Access to multidisciplinary pain management treatment in Canada is limited, with wait times up to 4 years. Stepped care approaches to mental health treatment have led to substantial reduction and elimination of wait times and may be applicable to chronic pain settings. There is no unifying framework for stepped care chronic pain programs. A systematic review of the efficacy of stepped care in chronic pain management conducted by the Canadian Agency for Drugs and Technologies reported varied results that may be due to heterogeneous stepped care models across facilities. Aim We propose a unifying framework for multidisciplinary stepped care chronic pain programs and present its application at The Ottawa Hospital Pain Clinic. The Ottawa Hospital stepped care framework is an eight-tiered approach that allows patients the opportunity to decide collaboratively with a health care professional which treatment program will best suit their needs for the management of chronic pain. As levels of stepped care increase, the time and resource commitment to each step will also increase. Treatment is stepped up or down, depending on patient needs. Method This is a descriptive case study. Results Implementing the interprofessional model of care with the stepped care program has eliminated wait times for access to The Ottawa Hospital Pain Clinic Interprofessional Chronic Pain Management Program and has improved communication between professions of the interprofessional team, resulting in better care for patients. Conclusion More research is needed to further develop and evaluate the clinical efficacy of stepped care to manage chronic pain.

Cluster analysis of Canadian Armed Forces veterans living with chronic pain: Life After Service Studies 2016

“…The heterogeneity findings support calls for person-centered care that can match individuals’ needs for specific types and intensity of services. 2 , 18 , 24 Although we cannot draw conclusions about causality from cross-sectional data, it is well established that the experience and impact of chronic pain in individuals’ lives is attributed to a variety of biological, developmental, and environmental factors across the life course, including adverse childhood experiences. 2 , 6 , 18 , 42 , 47 , 48 Stepped, stratified, and matched chronic pain care models have been proposed to address individual needs for health care and supports in any of the well-being domains in ways that efficiently utilize effective support services.…”

“…However, that finding does not suggest that they would not benefit from interdisciplinary care, and some likely would benefit from specialized care early on to prevent progression into more complex states. 22 , 24 The finding that half of those with chronic pain were in clusters II and III suggests the extent of the need for specialized interdisciplinary services for these veterans.…”

“…There is substantial evidence of the importance of addressing mental health and well-being in other domains in veterans with chronic pain. 2 , 5 , 6 , 11 , 18 , 23 , 24 , 27 , 47 , 50 Determinants of mental health arise from multiple well-being domains and, conversely, adverse mental health can influence pain experiences and well-being in multiple aspects of life. 6 , 11 , 19 , 47 …”

“…There is need for research that maps and evaluates the effectiveness of individual pathways to good well-being for CAF veterans with chronic pain. 2 , 18 , 24 , 49 Though there are some observational data about outcomes for CAF veterans in least one specialized pain center, 50 little is known about the nature and effectiveness of health care and supports received by most CAF veterans with chronic pain. As in the United States, 23 further research is needed to identify existing pathways for CAF veterans with chronic pain, explore triage strategies based on veterans’ individual needs, and conduct clinical trials to assess the effectiveness of integrated person-centered, multidisciplinary care models.…”

“… 23 A variety of options for organizing care have been proposed, including stepped, stratified, and matched care models. 2 , 22 Although there is emerging evidence for various approaches, 2 , 22 , 24 no consensus has been achieved in Canada, each has disadvantages, and there are considerable systemic barriers to organizing chronic pain care. 2 , 18 , 22 , 25 Though there is some basic epidemiologic information about chronic pain prevalence and correlates in CAF serving members and veterans, 5 , 8 , 26 , 27 there is no assessment of heterogeneity in this population to support policy development, programming, research, and service model development.…”