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Brain Morphology of Cannabis Users With or Without Psychosis: A Pilot MRI Study

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Lessons learned from piloting a pain assessment program for high frequency emergency department users.

Rebecca Cherner^1,2, John Ecker^1,2, Alyssa Louw^1,2

¹Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Canada.

Scandinavian Journal of Pain

|April 30, 2019

Summary

This study evaluated a program for high-frequency users of emergency departments (EDs) with chronic pain (CP). The program improved care and reduced ED visits, but challenges in service coordination and accessibility need addressing for future development.

Keywords:

chronic pain diversion program emergency department

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Area of Science:

Pain Management
Healthcare System Evaluation
Interdisciplinary Care

Background:

Chronic pain (CP) management is challenging, leading many patients to inappropriate emergency department (ED) visits.
High-frequency users (HFUs) of EDs often present with CP, indicating a gap in accessible care.
A Rapid Interdisciplinary Pain Assessment Program was developed for CP patients with ≥12 ED visits annually.

Purpose of the Study:

To evaluate the implementation and effectiveness of the Rapid Interdisciplinary Pain Assessment Program.
To identify strengths and areas for improvement to guide future program development and clinical trials.
To describe lessons learned for creating similar programs for high-frequency ED users with chronic pain.

Main Methods:

A qualitative evaluation using semi-structured interviews and focus groups.
Participants included patients, ED staff, primary care physicians, Pain Clinic physicians, and program staff (n=35).
Inquiries focused on program implementation, strengths, and areas needing improvement.

Main Results:

The program generally provided planned interdisciplinary assessments and individualized treatment plans.
Patients received education, pain management, substance use, and psychological treatments.
Perceived strengths included quick access, comprehensive plans, and interdisciplinary approach; challenges involved service coordination, accessibility, and patient-provider communication.

Conclusions:

The program demonstrated strengths in improving care for HFUs with CP and reducing ED utilization.
Challenges related to service coordination, accessibility, and communication require attention in program design.
Future programs should consider strategies like case management and enhanced inter-professional communication to optimize care for chronic pain patients.