Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program

Abstract

Purpose

There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care.

Methods

Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups.

Results

Challenges identified in focus group discussions were related to five dimensions: knowledge gap, “work in silos”, lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs.

Conclusion

Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients.

Keywords:

• chronic pain
• community-based participatory research
• health service accessibility
• patient-centered care
• primary health care

Supplementary material

Table

Research funding

Canadian Institutes of Health Research (CIHR) in partnership with AstraZeneca, Pfizer Canada Inc., Janssen-Ortho, Merck Frost Canada Ltd, and Purdue Pharma.

Disclosure

Marie-Claude Laliberté is an employee of AbbVie Corporation and owns AbbVie shares. At the time of analysis, she was a PhD student in pharmaceutical sciences at Université de Montréal. The other authors have no conflicts of interest to declare.