Liddy Clare, Poulin Patricia A, Hunter Zoë, Smyth Catherine, Keely Erin
C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Psychology, Ottawa, Ontario, Canada.
Scand J Pain. 2017 Oct;17:53-57. doi: 10.1016/j.sjpain.2017.07.015. Epub 2017 Jul 27.
Chronic pain is a debilitating condition that requires prompt access to care for effective treatment. Wait times for care often exceed benchmark recommendations, with potential consequences to patient health outcomes. The goal of this paper is to gain the perspectives of patients attending a chronic pain clinic regarding the acceptability of current wait times and the impact of their experiences of waiting for chronic pain care.
The study took place in a chronic pain clinic at an academic-affiliated teaching hospital in Ottawa, Canada, which housed seven clinicians at the time of the study. New patients attending the chronic pain clinic between July 14, 2014 and August 5, 2015 were eligible to participate based on the availability of the research and clerical staff who administered the survey on a variety of days over the course of the study. Patients completed a self-administered 29-item survey. The survey took approximately five to ten minutes to complete. Questions pertained to patients' socioeconomic factors, chronicity and burden of pain symptoms, and satisfaction with current wait times. Actual wait times were self-reported. Survey results were entered into an Excel spreadsheet, exported to SPSS, and coded numerically to facilitate descriptive analyses using comparative graphs and tables. Open-text responses were reviewed by the authors.
Sixty-six patients completed the survey. While 83% of patients stated that their ideal wait time was less than three months, 32% reported receiving an appointment within this period, and 31% reported waiting a year or more. Only 37% of patients felt the wait time for their appointment was appropriate. During their wait, 41% of patients reported receiving written information about chronic pain and 47% were referred to a local chronic pain management group. 94% reported interference with social/recreational activities and normal activities of daily living, 31% had to miss work or school due to the frequency of ongoing symptoms, and 22% reported being unable to attend work or school altogether. Furthermore, 37% of patients reported visiting the emergency room within the previous year and 65% worried about having a serious undiagnosed disease.
Our study found that wait times for chronic pain care, even those triaged as urgent cases, far exceeded what patients considered ideal. Only a third of patients received care within three months of making their appointment, while nearly another third waited over a year. During the waiting period, nearly all patients experienced some impact on their day-to-day activities and work or school attendance, half were unemployed, and nearly a quarter reported a complete inability to attend work or school because of pain.
Wait times for chronic pain care exceed timelines deemed acceptable by patients, causing anxiety and reducing function. The patient perspective must be considered in initiatives attempting to improve access to care for this population with specific needs and goals. Innovative solutions, such as electronic consultation and shared care models, hold promise.
慢性疼痛是一种使人衰弱的病症，需要及时获得治疗以进行有效干预。就诊等待时间常常超过基准建议，这可能对患者的健康状况产生影响。本文旨在了解慢性疼痛门诊患者对当前等待时间的可接受程度，以及等待慢性疼痛治疗的经历所产生的影响。
本研究在加拿大渥太华一家学术附属教学医院的慢性疼痛门诊开展，研究期间该门诊有七名临床医生。2014年7月14日至2015年8月5日期间到该慢性疼痛门诊就诊的新患者，若研究及文书工作人员在研究期间的不同日子有空进行调查，则符合参与条件。患者完成一份29项的自填式调查问卷。完成该问卷大约需要五到十分钟。问题涉及患者的社会经济因素、疼痛症状的慢性程度和负担，以及对当前等待时间的满意度。实际等待时间由患者自行报告。调查结果录入Excel电子表格，导出至SPSS，并进行数字编码，以便使用比较图表进行描述性分析。作者对开放式回答进行了审核。
66名患者完成了调查。虽然83%的患者表示他们理想的等待时间少于三个月，但32%的患者报告在此期间获得了预约，31%的患者报告等待了一年或更长时间。只有37%的患者认为其预约等待时间是合适的。在等待期间，41%的患者报告收到了有关慢性疼痛的书面信息，47%的患者被转介到当地的慢性疼痛管理小组。94%的患者报告社交/娱乐活动和日常生活受到干扰，31%的患者因持续症状频繁发作而不得不缺勤或缺课，22%的患者报告完全无法上班或上学。此外，37%的患者报告上一年去过急诊室，65%的患者担心患有严重的未确诊疾病。
我们的研究发现，慢性疼痛治疗的等待时间，即使是那些被归类为紧急病例的患者，也远远超过了患者认为理想的时间。只有三分之一的患者在预约后三个月内得到治疗，而近三分之一的患者等待了一年以上。在等待期间，几乎所有患者的日常活动以及工作或上学出勤都受到了一定影响，一半患者失业，近四分之一的患者报告因疼痛完全无法上班或上学。
慢性疼痛治疗的等待时间超过了患者认为可接受 的时间范围，导致焦虑并降低了功能。在试图改善这一有特定需求和目标人群的就医机会的举措中，必须考虑患者的观点。诸如电子会诊和共享护理模式等创新解决方案具有前景。
