Canadian Family Physician最新文献

Objective: To familiarize family physicians with new and emerging evidence regarding the underlying central nervous system (nociplastic) pathogenesis of many chronic pain conditions and review modalities of psychotherapy that can specifically target nociplastic pain and other symptoms.

Quality of evidence: Psychotherapy modalities for the treatment of patients with nociplastic chronic pain (eg, pain reprocessing therapy, emotional awareness and expression therapy, intensive short-term dynamic psychotherapy) have level I evidence to support their efficacy in treating patients with various pain conditions as well as those with other chronic symptoms lacking clear structural causes.

Main message: Family physicians should be aware that many patients with chronic pain and other persistent symptoms may benefit from therapeutic approaches that target the central nervous system rather than the site where symptoms are felt. Meta-analyses have shown that older nonspecific modalities of psychotherapy (eg, cognitive behavioural therapy, acceptance and commitment therapy) have limited efficacy in treating patients with these conditions. Recent trial evidence and systematic reviews have shown that pain reprocessing therapy, emotional awareness and expression therapy, and intensive short-term dynamic psychotherapy can be helpful for many patients with nociplastic symptoms and may also help improve comorbid mood and anxiety symptoms.

Conclusion: Psychotherapy is a safe and effective way to treat patients with chronic pain conditions that have nociplastic components. Access to effective therapy modalities may be a limiting factor, but self-treatment using online or virtual resources can be helpful for many patients.

Objective: To identify social and health determinants affecting wait times for primary care in Canada.

Design: Secondary analysis of national survey data.

Setting: Canada.

Participants: Canadian Community Health Survey participants aged 18 years or older during the 2015, 2016, and 2019 cycles.

Main outcome measures: Weighted summary statistics and a partial proportional odds regression model were used to assess relationships between patient-level social and health determinants and wait times for primary care (ranging from same-day appointments to waits of 1 month or longer).

Results: A weighted sample of 9,380,662 participants across the 3 survey cycles was used. Participants had a mean age of 49.7 years (standard deviation=17.5), 55.7% were female, and 74.7% were white. Approximately 57.4% of participants waited less than a week for care while 11.0% waited 1 month or longer. Factors associated with higher odds of waiting at least 1 month for a consultation were attaining only a high school diploma (adjusted odds ratio [aOR]=1.12, 95% CI 1.01 to 1.23) compared with having postsecondary education; identifying as Asian (aOR=1.42, 95% CI 1.20 to 1.67) or Black (aOR=1.57, 95% CI 1.16 to 2.13) compared with identifying as white; having "excellent" self-reported health status (aOR=1.10, 95% CI 1.02 to 1.19) compared with "good" self-reported health; lacking a regular primary care provider (aOR=1.47, 95% CI 1.27 to 1.71) compared with having a regular provider; or being classified as having multimorbidity (aOR=1.11, 95% CI 1.01 to 1.21) compared with having no chronic condition.

Conclusion: Wait times for primary care were found to be associated with patient-level social and health determinants including race, education level, absence or presence of a regular health care provider, self-reported health status, and multimorbidity. Future research could investigate health system determinants of wait times to inform specific policy measures designed to reduce disparities in access to care.