Evaluation of the Impact of an Novel Interdisciplinary Chronic Pain Clinic Using Linked Administrative Health Databases

Background: Access to interdisciplinary chronic pain clinics is limited in many countries primarily due to a lack of specialist physicians who typically lead these clinics. The USask Chronic Pain Clinic (UCPC) was created using a novel model that includes a limited virtual physician role and expanded integrated roles for a team of pharmacists, physiotherapists, and social workers. The aim of the research was to evaluate the impact of the UCPC on health services utilization using a retrospective analysis of linked administrative health databases.

 

Approach: All patients referred to UCPC from March 2020 – January 2023 were included. Using existing provincial linked health administrative databases patient rates of hospital admissions, emergency department visits, and outpatient physician visits were measured and compared for the 6-month period prior to each patient’s initial appointment at the UCPC and the 6-month period after discharge.

 A bivariate analysis (chi-square test) was conducted to assess the differences in visit counts before and after the UCPC program within each of the 3 datasets. In addition, a random effects binary logistic regression model was used to assess the differences in hospitalization rates.

 

Results: A total of 284 patients were included, 68% female with the majority (61%) over the age of 50 years. The rate of emergency department visits was similar in the 6 months before compared with the 6 months after attending the UCPC (1.1 visits per patient in both timeframes, p=0.60). The number of outpatient physician visits was also similar in the 6 months before compared with the 6 months after attending the UCPC (17.4 per patient vs. 16.9 per patient, p=0.64). The rate of hospitalizations was significantly lower in the 6 months after attending the UCPC compared with the 6 months before (0.39 vs. 0.52 hospitalizations per patient, p=0.046).

 

Implications: The novel model of interdisciplinary chronic care at the UCPC that incorporates a limited virtual role for specialist physicians and an expanded integrated role for pharmacists, physiotherapists and social workers appears to significantly reduce hospitalization rates in the 6 months after discharge from the program. Future research should confirm these findings using controlled, prospective methodologies and determine if the impact is sustained beyond 6 months.