학술논문
Improving access to chronic pain care with central referral and triage: The 6-year findings from a single-entry model.
Document Type
Academic Journal
Author
Di Renna T; Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Ontario, Canada.; Burke E; Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Ontario, Canada.; Bhatia A; Department of Anesthesiology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.; Clarke H; Department of Anesthesia and Pain Medicine, Toronto General Hospital, Toronto, Ontario, Canada.; Flamer D; Department of Anesthesiology, University of Toronto, Sinai Health, Toronto, Ontario, Canada.; Flannery J; Musculoskeletal Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada.; Furlan A; Musculoskeletal Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada.; Kumbhare D; Musculoskeletal Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada.; Khan J; Department of Anesthesiology, University of Toronto, Sinai Health, Toronto, Ontario, Canada.; Ladha K; Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.; Meng H; Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Ontario, Canada.; Department of Anesthesiology and Pain Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Smith A; Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.; Sussman D; Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.; Bosma R; Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Ontario, Canada.
Source
Publisher: Taylor & Francis Country of Publication: United States NLM ID: 101720589 Publication Model: eCollection Cited Medium: Internet ISSN: 2474-0527 (Electronic) Linking ISSN: 24740527 NLM ISO Abbreviation: Can J Pain Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Background: Despite the established efficacy of multidisciplinary chronic pain care, barriers such as inflated referral wait times and uncoordinated care further hinder patient health care access.
Aims: Here we describe the evolution of a single-entry model (SEM) for coordinating access to chronic pain care across seven hospitals in Toronto and explore the impact on patient care 6 years after implementation.
Methods: In 2017, an innovative SEM was implemented for chronic pain referrals in Toronto and surrounding areas. Referrals are received centrally, triaged by a clinical team, and assigned an appointment according to the level of urgency and the most appropriate care setting/provider. To evaluate the impact of the SEM, a retrospective analysis was undertaken to determine referral patterns, patient characteristics, and referral wait times over the past 6 years.
Results: Implementation of an SEM streamlined the number of steps in the referral process and led to a standardized referral form with common inclusion and exclusion criteria across sites. Over the 6-year period, referrals increased by 93% and the number of unique providers increased by 91%. Chronic pain service wait times were reduced from 299 (±158) days to 176 (±103) days. However, certain pain diagnoses such as chronic pelvic pain and fibromyalgia far exceed the average.
Conclusions: The results indicate that the SEM helped reduce wait times for pain conditions and standardized the referral pathway. Continued data capture efforts can help identify gaps in care to enable further health care refinement and improvement.
Competing Interests: Anuj Bhatia is a consultant for Bioventus and has funded research from Medtronic. Hance Clarke receives salary support from a Merit Award from the Department of Anesthesiology and Pain Medicine. Andrea Furlan is a member of the Drug Advisory Committee on the Workplace Safety and Insurance Board, is receiving a grant from the Canadian Institutes for Health research (CIHR) and the Canadian Generic Product Association, has received payments from Google Inc. as a member of the YouTube partner program, and holds a patent for the My Opioid Manager App. All other authors have no conflicts of interest to declare.
(© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC.)
Aims: Here we describe the evolution of a single-entry model (SEM) for coordinating access to chronic pain care across seven hospitals in Toronto and explore the impact on patient care 6 years after implementation.
Methods: In 2017, an innovative SEM was implemented for chronic pain referrals in Toronto and surrounding areas. Referrals are received centrally, triaged by a clinical team, and assigned an appointment according to the level of urgency and the most appropriate care setting/provider. To evaluate the impact of the SEM, a retrospective analysis was undertaken to determine referral patterns, patient characteristics, and referral wait times over the past 6 years.
Results: Implementation of an SEM streamlined the number of steps in the referral process and led to a standardized referral form with common inclusion and exclusion criteria across sites. Over the 6-year period, referrals increased by 93% and the number of unique providers increased by 91%. Chronic pain service wait times were reduced from 299 (±158) days to 176 (±103) days. However, certain pain diagnoses such as chronic pelvic pain and fibromyalgia far exceed the average.
Conclusions: The results indicate that the SEM helped reduce wait times for pain conditions and standardized the referral pathway. Continued data capture efforts can help identify gaps in care to enable further health care refinement and improvement.
Competing Interests: Anuj Bhatia is a consultant for Bioventus and has funded research from Medtronic. Hance Clarke receives salary support from a Merit Award from the Department of Anesthesiology and Pain Medicine. Andrea Furlan is a member of the Drug Advisory Committee on the Workplace Safety and Insurance Board, is receiving a grant from the Canadian Institutes for Health research (CIHR) and the Canadian Generic Product Association, has received payments from Google Inc. as a member of the YouTube partner program, and holds a patent for the My Opioid Manager App. All other authors have no conflicts of interest to declare.
(© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC.)