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Mapping care pathways and estimating the number and cost of musculoskeletal chronic pain patients to inform the development and implementation of a new service
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Carnes, Dawn, Gallagher, Jayne, Herne, Sally, Munday, Elaine, Ritchie, Sara and Underwood, Martin (2008) Mapping care pathways and estimating the number and cost of musculoskeletal chronic pain patients to inform the development and implementation of a new service. Primary Health Care Research & Development, Vol.9 (No.4). pp. 241-247. doi:10.1017/S1463423608000893 ISSN 1463-4236.
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Official URL: http://dx.doi.org/10.1017/S1463423608000893
Abstract
Background Patients living with chronic pain are typically resource intensive, their care requirements are long term and referral to secondary care is not always expeditious. To provide more appropriate, accessible and cost-effective care, Tower Hamlets Primary Care Trust reviewed the needs of the patients, their current care and the numbers requiring treatment for non-malignant chronic pain, initially starting with musculoskeletal pain.
Method We estimated the number of people with chronic pain being treated outside general practice by the NHS in Tower Hamlets. A working group established set criteria to define a chronic pain patient. We surveyed appropriate clinicians to determine the approximate number of patients who fitted our inclusion criteria, the approximate number of follow-up appointments they required and their care pathways. Secondly, we estimated the cost of care for chronic pain patients using NHS national tariff and reference cost data. We also took a convenience sample of chronic pain patients and recorded their history of care.
Findings The routes and pathways of care are complex and multiple. We estimate between 4.0% and 5.5% of new patients in rheumatology, orthopaedics, occupational therapy and musculoskeletal physiotherapy and up to 90% in the pain clinic are people living with chronic pain. The cost of this care ranged from £296 for a course of physiotherapy to £1911 for a patient seen in physiotherapy, orthopaedic and the pain clinics.
Conclusion There is no facility in current management information services that identifies people being treated for non-specific chronic pain; therefore, estimating both the numbers and costs for treating these people is difficult. National tariff and notional cost data provide estimates only, of an ‘average patient’; the real cost of these patients is unknown.
| Item Type: | Journal Article | ||||
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| Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Chronic pain -- Treatment, Medical care, Cost of, Musculoskeletal system -- Diseases -- Patients, Health planning | ||||
| Journal or Publication Title: | Primary Health Care Research & Development | ||||
| Publisher: | Cambridge University Press | ||||
| ISSN: | 1463-4236 | ||||
| Official Date: | October 2008 | ||||
| Dates: |
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| Volume: | Vol.9 | ||||
| Number: | No.4 | ||||
| Page Range: | pp. 241-247 | ||||
| DOI: | 10.1017/S1463423608000893 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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