The association between waiting time and multidisciplinary pain treatment outcomes in patients with rheumatic conditions

Abstract

Background Access to multidisciplinary pain treatment facilities (MPTF) is limited by extensive waiting time in many countries. However, there is a lack of knowledge about the impact of waiting time on clinical outcomes, particularly for patients with rheumatic conditions. This study examined the association between waiting time for MPTF and clinical outcomes in patients with rheumatic conditions. Methods Data were extracted from the Quebec Pain Registry, a large database of patients who received services in MPTF. The associations between waiting time (classified as < 2 months, 2–6 months and > 6 months) and change in pain interference, pain intensity and health-related quality of life, from the initial visit at the MPTF to the 6-month follow-up, were tested using generalized estimating equations. Results A total of 3230 patients with rheumatic conditions (mean age: 55.8 ± 14.0 years; 66% were women) were included in the analysis. Small significant differences in improvement between waiting time groups were revealed, with patients waiting less than 2 months having a larger improvement in all clinical outcomes compared to patients who waited 2–6 months or over 6 months before their initial visit (adjusted time X group effect p ≤ 0.001). Only patients waiting less than 2 months reached a clinically important improvement in pain interference (1.12/10), pain intensity (1.3/10) and physical and mental quality of life (3.9 and 3.7/100). Conclusions Longer delays experienced by patients before receiving services in MPTF were associated with statistically significant smaller improvements in pain interference, pain intensity and health-related quality of life; these differences were, however, not clinically significant. Based on these results, we advise that strategies are developed not only to reduce waiting times and mitigate their impacts on patients with rheumatic conditions, but also to improve treatment effectiveness in MPTF.

“It feels like an endless fight”: a qualitative study exploring healthcare utilization of persons with rheumatic conditions waiting for pain clinic admission

“…A semi-structured interview guide was developed based on previous studies on access and the results of the first part of our mixed-method project, which was a database study using the Quebec Pain Registry [ 10 , 13 ]. Furthermore, the interview guide was continually adapted throughout data collection via an iterative process [ 26 ].…”

“…This qualitative approach is increasingly used in the health field [17][18][19]. This study was part of a mixedmethods project exploring access to pain clinics for individuals living with a rheumatic condition [10,13]. We conducted individual semi-structured interviews from June 2018 to February 2019.…”

“…In a previous study from our team, patients diagnosed with a rheumatic condition who waited less than 2 months before their initial visit in a pain clinic reported superior improvements after 6 months of treatment, compared to those who had to wait more than 2 months. This was observed for the following variables: pain intensity, pain interference, and physical and mental components of quality of life [ 13 ]. Being faced with extensive delays before receiving treatments in a pain clinic has also been associated with high financial costs, as patients on wait lists may seek different therapeutic modalities and services to alleviate pain and prevent loss of function [ 14 ].…”

Fractured system, fractured care: The experiences of Canadian women with chronic pelvic pain waiting for interprofessional pain care

“…8,9 Long wait times can lead to a deterioration in patients’ health, functioning, and quality of life, 10,11 and waiting for interprofessional care negatively impacts treatment outcomes once patients do receive treatment from an interprofessional pain clinic. 12…”

“…While previous studies have described the negative impact of waiting for chronic pain on health outcomes, 8,10–12 very few studies have explored the perceptions of individuals waiting for interprofessional care. 13 Furthermore, little is known about the patient experience related to navigating and interacting with the health care system while they seek CPP care.…”