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Pain Research and Management
Volume 10, Issue 3, Pages 155-157
Original Article

A Triage Approach to Managing a Two Year Wait-List in a Chronic Pain Program

Alexander J Clark,1,2 Ian Beauprie,3,4 Lynne B Clark,3 and Mary E Lynch3,4,5

1Chronic Pain Centre, Calgary Health Region, Canada
2Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
3Pain Management Unit, Queen Elizabeth II Health Sciences Centre, Capital Health, Canada
4Department of Anesthesiology, Dalhousie University, Halifax, Nova Scotia, Canada
5Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada

Copyright © 2005 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors' pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed.

METHODS: All referrals to the Queen Elizabeth II Health Sciences Centre's Pain Management Unit for a one-year period were reviewed and triaged as either 'regular waiting list' or 'fast track'. Patients in the fast track group were seen within four months and required limited interventions or were urgent in nature. The regular waiting list group waited up to 27 months for assessment and development of a treatment plan. Treatment recommendations were faxed to the referring physician. A follow-up questionnaire was sent to each physician to assess whether these treatment recommendations were useful.

RESULTS: Recommendations were faxed for 297 patients. One hundred forty-nine physicians returned the follow-up questionnaire. Ninety-five physicians used the recommendations and 68 patients followed the recommendations. Seventy-nine physicians felt that the recommendations were helpful to them in their care of the patient. For 39 patients, the recommendations were helpful. The most frequently used recommendations were those on medications (eg, tricylic antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drugs and controlled-release opioids). Other modalities included participation in an interdisciplinary group program and physiotherapy.

CONCLUSIONS: A triage review process with recommendations faxed to referring physicians was developed and put into action for one year. The recommendations were used by 32% of the physicians (64% of responding physicians). Fifty-three per cent of responding physicians felt that the recommendations were helpful in the care of their patient. This process led to a benefit in care, as perceived by the physician, in 26% of patients (of physicians who returned the questionnaire [13% of all patients]) on the waiting list for a tertiary care pain management unit.