Models of Care for Chronic Pain

Abstract


 For chronic pain, 1 hub-and-spoke model and 4 stepped care models for the delivery of care in Canada and internationally were identified and described. No information was found on the use of the Oncology Care Model for chronic pain.
 For other medical conditions, 9 stepped care models, 5 hub-and-spoke models, and the Oncology Care Model for the delivery of care in Canada and internationally were identified and described.
 Patient-related outcomes used to evaluate the effectiveness of models of care for chronic pain include pain measures (e.g., intensity, duration), psychosocial outcomes (e.g., anxiety, depression), functional outcomes (e.g., disability, employment status), and health care utilization (e.g., opioid prescriptions, health care visits). 
 Various barriers and facilitators to providing care for patients with chronic pain were identified in the consultations and the literature. The most common factors that influenced the care provided to patients with chronic pain pertained to funding, support, and collaboration from the government and locally; having a centralized intake and referral system; and leveraging existing resources. 
 There appears to be considerable variation in the models of care used to address the care needs of patients with chronic pain. In Canada, there are provincial, regional, and local models, and local programs; some regions do not have a formalized approach for the provision of care for chronic pain patients.

Evaluation of a pharmacist-led interprofessional chronic pain clinic in Canada

“…1,3 Unfortunately, waitlists to access ICPCs are exceptionally long, and in many areas these clinics do not exist. 2 A recent study found that 9 of 10 Canadian provinces have at least 1 ICPC, but most had only 1 clinic per 300,000 people, the majority of whom were located in large urban centres. 2 There are many documented barriers to increasing access to ICPCs, the greatest and most obvious being the significant expense required to operate these clinics.…”

“…2 A recent study found that 9 of 10 Canadian provinces have at least 1 ICPC, but most had only 1 clinic per 300,000 people, the majority of whom were located in large urban centres. 2 There are many documented barriers to increasing access to ICPCs, the greatest and most obvious being the significant expense required to operate these clinics. 1,3 Additionally, there is a well-documented lack of medical professionals, particularly physicians, who have the specialized training, expertise and willingness to practice in chronic pain.…”

“…2 A recent study found that 9 of 10 Canadian provinces have at least 1 ICPC, but most had only 1 clinic per 300,000 people, the majority of whom were located in large urban centres. 2…”

“…1,3 Unfortunately, waitlists to access ICPCs are exceptionally long, and in many areas these clinics do not exist. 2 A recent study found that 9 of 10 Canadian provinces have at least 1 ICPC, but most had only 1 clinic per 300,000 people, the majority of whom were located in large urban centres. 2…”

“…Management of chronic pain is a challenge for health systems due to the complex approach to treatment, the large numbers of people affected and the lack of a formalized system of care in some regions. 2 It is estimated that 1 in 5 Canadians experiences chronic pain. 1 The treatment of chronic pain is further complicated by the opioid crisis and the increased awareness of avoiding unnecessary opioid use.…”