Derek Jorgenson, University Of Saskatchewan, Saskatchewan, Canada
Katelyn Halpape, University Of Saskatchewan, Saskatchewan, Canada
Anan Ahmed, University Of Saskatchewan, Saskatchewan, Canada
Isobel Johnston, University Of Saskatchewan, Saskatchewan, Canada
Jennifer King, University Of Saskatchewan, Saskatchewan, Canada
Kelly Kizlyk, University Of Saskatchewan, Saskatchewan, Canada
Eric Landry, University Of Saskatchewan, Saskatchewan, Canada
Taylor Raiche, University Of Saskatchewan, Saskatchewan, Canada
Tanis Walmsley, University Of Saskatchewan, Saskatchewan, Canada
Amy Wiebe, University Of Saskatchewan, Saskatchewan, Canada
ABSTRACT
Background Information
One in five Canadians experience chronic pain, yet many have limited access to interprofessional chronic pain management programs, which are recommended by professional practice guidelines. Access is particularly difficult for people living in rural and remote regions. The University of Saskatchewan (USask) Chronic Pain Clinic was established in 2020 to fill this gap. The USask Chronic Pain Clinic is a pharmacist-led interprofessional clinic at the College of Pharmacy and Nutrition, University of Saskatchewan, Canada.
The clinical team includes 4 pharmacists, 3 social workers, 2 physical therapists, and 1 part-time chronic pain physician. Services focused on the 3M’s of chronic pain management (mind, movement, medications) are delivered virtually for any resident of the Province of Saskatchewan or in-person in the City of Saskatoon.
Purpose
To evaluate the effectiveness of the USask Chronic Pain Clinic.
Method
A retrospective chart audit of the first 103 patients who were referred to the program was completed in 2021. A postal survey was also mailed to patients and their referring healthcare professionals 3 months after the patient was referred to the program.
Result
The mean age of patients in the chart audit was 57 years (range 22-87) and 72.8% (n=75/103) were using an opioid at initial referral, with a mean morphine equivalent (MME) dose of 233mg/day. Five of the 75 patients (6.7%) taking an opioid at initial referral were switched to buprenorphine/naloxone and those who remained on an opioid had their MME dose reduced by a mean of 14.2% (from 233mg/day to 200mg/day). Mean Clinical Global Impression-Severity (CGI-S) scale scores, a measure of overall disease severity, improved from 4.1 (moderately ill) to 3.4 (mildly ill). Naloxone kits were provided to 11 patients. Patient survey response rate was 33.3% (n=26/78) and almost all (96.2%, n=75/78) reported to be ‘very satisfied or satisfied’ with their experience at the USask Chronic Pain Clinic and 61.5% (n=48/78) reported that their overall health status was ‘much improved or improved’. Health professional survey response rate was 33.8% (n=21/62) and 100% responded that they would ‘recommend the clinic to their colleagues’ and that the ‘consultations were helpful’. In addition, 52.4% felt more confident in prescribing opioids after having their patient come to the clinic and 71.4% were more confident in managing chronic pain.
Conclusion
This study provides preliminary data to suggest the novel pharmacist-led interprofessional approach utilized at the USask Chronic Pain Clinic may improve the overall self-reported health status of people living with chronic pain. The study also suggests that the clinic may improve overall chronic pain severity, while facilitating safer opioid use (i.e., lower opioid doses, transition to buprenorphine/naloxone from full opioid agonists, providing naloxone kits). The USask Chronic Pain Clinic was also well received by patients/referring health professionals and improved the confidence of health professionals in managing chronic pain and prescribing opioids. Additional research using methodologies such as a randomized controlled trials are needed to confirm these results.