Referral pathways for chronic pain patients from Canadian emergency departments: emergency physicians' practices, perspectives, and recommendations.

IF 2 4区 医学 Q2 EMERGENCY MEDICINE Canadian Journal of Emergency Medicine Pub Date : 2023-09-01 Epub Date: 2023-08-26 DOI:10.1007/s43678-023-00566-3
Kiran L Grant, Aidan L McParland, Mario Francispragasam, Patrick Oxciano
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Abstract

Background: Patients with chronic pain account for 12-20% of total emergency department (ED) and was the primary presenting concern among 37% of patients who visited the ED > 12 times per year. Despite this, emergency physicians receive little focused training managing these patients, and there is a paucity of effective referral pathways from EDs, despite strong evidence that chronic pain is best treated longitudinally in multidisciplinary clinics. This study sought to explore the practices, perspectives, and recommendations of current Canadians emergency physicians in better serving the chronic pain patient (CPP) population in the ED.

Methods: An electronic cross-sectional survey was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of 16 multiple choice and numerical response questions. Responses were summarized descriptively as percentages and as the median and inter-quartile range (IQR) for quantitative variables.

Results: The study was completed by 169/1635 respondents for a response rate of 10%. The most common presentations respondents saw were neuropathic pain and centrally mediated disorders (23% each) and low back pain (19%). 86% of respondents felt that chronic pain patients did not get appropriate referrals from the ED, and 70% of respondents were unaware of where they could even refer chronic pain patients from the ED. 96% of respondents felt that their ED did not have an effective referral pathway for chronic pain patients. Rapid access clinics for common conditions, reduced pain clinic wait times, and clear ED referral pathways were the commonest recommendations by respondents.

Conclusion: There is a clear need to increase the accessibility to outpatient pain medicine clinics for chronic pain patients presenting to the ED. ED and pain medicine providers must collaborate to establish mutually beneficial referral pathways from EDs, and to advocate for increased funding for rapid access outpatient pain clinics.

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加拿大急诊科慢性疼痛患者的转诊途径:急诊医生的实践、观点和建议。
背景:慢性疼痛患者占急诊科总人数的12-20%,是37%急诊科就诊患者的主要关注点 > 每年12次。尽管如此,急诊医生很少接受有针对性的培训来管理这些患者,而且急诊科也缺乏有效的转诊途径,尽管有强有力的证据表明慢性疼痛最好在多学科诊所进行纵向治疗。本研究旨在探索当前加拿大急诊医生在更好地为ED中的慢性疼痛患者(CPP)人群服务方面的做法、观点和建议。方法:对加拿大急诊医生协会(CAEP)的成员进行了一项电子横断面调查,包括16个多选和数字回答问题。反应被描述为百分比,以及定量变量的中位数和四分位间距(IQR)。结果:169/1635名受访者完成了这项研究,应答率为10%。受访者最常见的表现是神经性疼痛和中枢性疾病(各23%)以及腰痛(19%)。86%的受访者认为慢性疼痛患者没有从ED获得适当的转诊,70%的受访者甚至不知道他们可以从哪里转诊慢性疼痛患者。96%的受访者认为他们的ED没有有效的慢性疼痛患者转诊途径。受访者最常见的建议是快速就诊,减少疼痛门诊等待时间,明确急诊转诊途径。结论:对于急诊科就诊的慢性疼痛患者,显然需要增加门诊疼痛药物诊所的可及性。急诊科和疼痛药物提供者必须合作,从急诊科建立互利的转诊途径,并倡导增加快速门诊疼痛诊所的资金。
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来源期刊
Canadian Journal of Emergency Medicine
Canadian Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
2.90
自引率
12.50%
发文量
171
审稿时长
>12 weeks
期刊介绍: CJEM is a peer-reviewed journal owned by CAEP. CJEM is published every 2 months (January, March, May, July, September and November). CJEM presents articles of interest to emergency care providers in rural, urban or academic settings. Publishing services are provided by the Canadian Medical Association.
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